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SAN JOAQU :OUNTY ENVIRONMENTAL HEALT. cPARTMENT <br />Changes to EnvisionConnect by CERS Integration Wizard <br />Date run: 1/15/2015 <br />Submitted on: 1/7/2015 9:34:15AM <br />Submitted by: Jennifer Bathe Email: jenniferb@mcdsjc.com <br />CERS ID: 10181035 <br />Facility ID in CERS: FA0002972 <br />McDonald's #12264 <br />Information prior to CIW processing <br />Information after CIW processing <br />CERS <br />OWNER INFORMATION <br />(current EC database) <br />(current submittal) <br />field <br />Owner ID <br />OW0000446 <br />Contact phone <br />209-938-1238 <br />Owner name <br />SCHRADER, DON <br />Craig Schrader <br />111 <br />Mailing address <br />4502 GEORGETOWN PL STE 100 <br />4502 Georgetown Place <br />113 <br />STOCKTON, CA 95207 <br />Stockton, CA 95207 <br />114, 115, 116 <br />Work phone <br />209-938-1238 <br />209-478-0234 <br />112 <br />FACILITY FILE INFORMATION <br />Facility ID <br />FA0002972 <br />Facility name <br />MCDONALDS #12264 <br />MCDONALDS #12264 <br />3 <br />Site address <br />1820 W ELEVENTH St <br />1820 W 11TH ST <br />103 <br />City <br />Tracy <br />TRACY <br />104 <br />ZIP code <br />95376 <br />95376 <br />105 <br />Facility phone <br />209-835-2946 <br />(209) 835-2946 <br />102 <br />Facility mailing address <br />4502 GEORGETOWN PL #100 <br />4502 Georgetown Place <br />108a <br />STOCKTON, CA 95207-6255 <br />Stockton, CA 95207 <br />108b, 108c, 108d <br />BILLING INFORMATION <br />Contact name <br />MCDONALDS #12264 <br />McDonald's #12264 <br />140 <br />Address <br />4502 GEORGETOWN PL #100 <br />4502 Georgetown Place <br />143 <br />STOCKTON, CA 95207-6255 <br />Stockton, CA 95207 <br />144, 145, 146 <br />Contact phone <br />209-938-1238 <br />209-938-1238 <br />141 <br />Contact email <br />jenniferb@mcdsjc.com <br />142 <br />Mail invoices to <br />F <br />Program record [ ] HMBP [ ] SQG HW [ ] LQG HW [ ] RCRA HW <br />created [ ] Tiered permit [ ] APSA [ ] CalARP [ ] UST <br />New PR#: _ <br />New PE: <br />Assigned to: <br />Please bill: [ ] full calendar year [ ] prorate this calendar year [ ] next calendar year [ ] exempt from billing <br />i <br />Processed through CERS Integration Wizard by:� Date: bvs-t5 <br />Accounting: Reviewed by: Date: a IS Clerical: [ ] File [ ] Relabel file [ ] Create new file <br />[ ] Acct billed [ ] Surcharge verified By: Date: <br />ACTIVE PROGRAM RECORDS PRIOR TO PROCESSING THROUGH CIW <br />Program Element and Description Record ID Employee name Status Reactivated Inactivated <br />1625 - RESTAURANT/BAR 51-100 SEATS PRO163372 MELISSA NISSIM Active [ ] [ ] <br />1921 - HMBP-Regular-Primary Location PR0520734 MICHAEL PARISSI Active [ ] [ ] <br />2399 - UNIFIED PROGRAM FAC STATE SURCHARGE FEE PRO511188 HAZ MAT SJC OES Inactive [ ] [ ] <br />ERSC - ELECTRONIC REPORTING STATE SURCHARGE FI PR0533483 not assigned Inactive [ ] [ ] <br />Piz`' S --s 14 <br />Q v a`�k- S c OAA <br />