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SAN JOAQUIN COUNTY ENVIRONMENTAL HEALTH DEPARTMENT <br />Changes to EnvisionConnect by CERS Integration Wizard <br />Date run: 5/11/2017 <br />Submitted on: 5/9/2017 9:06:02AM CERS ID: 10591051 <br />Submitted by: Sumera Awan Email: sumeraa@mcdsjc.com Facility ID in CERS: FA0021994 <br />OWNER INFORMATION <br />Owner ID <br />Owner name <br />Mailing address <br />Work phone <br />Information prior to CIW processing <br />(current EC database) <br />Number of Facilities for this Owner : 14 <br />OW0012665 <br />Craig Schrader <br />4502 GEORGETOWN PL STE 100 <br />STOCKTON, CA 95207 <br />209-938-1238 <br />FACILITY FILE INFORMATION <br />Facility ID <br />FA0021994 <br />Facility name <br />MCDONALDS 36229 <br />Site address <br />236 E ELEVENTH St <br />City <br />TRACY <br />ZIP code <br />95376 <br />Facility phone <br />209-221-8826 <br />Facility mailing address 4502 Georgetown Place <br />Stockton, CA 95207 <br />BILLING INFORMATION <br />Contact name <br />Address <br />Contact phone <br />Contact email <br />Mail invoices to <br />McDonald's #36229 <br />4502 Gerorgetown PL <br />Stockton, CA 95207 <br />209-938-1295 <br />amandai@mcdsjc.com <br />Account <br />Information after CIW processing CERS <br />(current submittal) field <br />Craig Schrader 111 <br />4502 Georgetown Place 113 <br />STOCKTON, CA 95207 114, 115, 116 <br />(209) 938-1238 112 <br />McDonald's 36229 <br />3 <br />236 E 11th St <br />103 <br />Tracy <br />104 <br />95376 <br />105 <br />(209) 221-8826 <br />102 <br />4502 Georgetown Place <br />108a <br />Stockton, CA 95207 <br />108b, 108c, 108d <br />McDonald's #36229 <br />140 <br />4502 Gerorgetown PL <br />143 <br />Stockton, CA 95207 <br />144, 145, 146 <br />2099381295 <br />141 <br />amandai@mcdsjc.com <br />142 <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 />Processed through CERS Integration Wizard by: �✓'^ Date: <br />--------------------- <br />Accounting: Reviewed by: L16 Date: 6WI 7 Clerical: [ ] File [ ] Relabel file [ ] Create new file <br />[ ] Acct billed [ ] Surcharge verified By: Date: <br />ACTIVE PROGRAM RECORDS PRIOR TO PROCESSING THROUGH CIW <br />Record ID Employee name Status Reactivated Inactivated <br />1625 - RESTAURANT/BAR 51-100 SEATS PR0538076 MELISSA NISSIM Active [ ] [ ] <br />1919 - HMBP-0O2 Only Food Facility 1 chem units PR0538763 MELISSA NISSIM Active [ ] [ ] <br />