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SAN JOAQUIN COUNTY ENVIRONMENTAL HEALTH DEPARTMENT <br /> Changes to EnvisionConnect by CERS Integration Wizard Date run: 6/1/2015 <br /> Submitted on: 5/28/2015 11:57:51AM CERS ID: 10184161 <br /> Submitted by: SumeraAwan Email: sumeraa@mcdsjc.com Facility ID in CERS: FA0012181 <br /> Information prior to CIW processing Information after CIW processing CERS <br /> OWNER INFORMATION (current EC database) (c rrent Ittal) fiield, <br /> Owner ID OW0000446 �� � <br /> Owner name SCHRADER, DON & NANCY AT /]�[cJ Qll, <br /> Mailing address 4502 GEORGETOWN PL STE 100 4502 GEORGETO N PL STE 100 113 <br /> STOCKTON, CA 95207 STOCKTON, CA 520 114, 115, 1 <br /> Work phone 209-938-1238 209-938-1238 <br /> FACILITY FILE INFORMATION <br /> Facility ID FA0012181 <br /> Facility name MCDONALDS#20612 MCDONALDS#20612 3 <br /> Site address 3355 E HAMMER LN 3355 E HAMMER LN 103 <br /> City STOCKTON STOCKTON 104 <br /> ZIP code 95210 95210 105 <br /> Facility phone 209-478-0234 (209)478-0234 102 <br /> Facility mailing address 4502 GEORGETOWN PL #100 4502 GEORGETOWN PL #100 108a <br /> STOCKTON, CA 95207-6255 STOCKTON, CA 95207-6255 108b, 108c,1084 <br /> BILLING INFORMATION <br /> Contact name MCDONALDS#20612 MCDONALDS#20612 140 <br /> Address 4502 GEORGETOWN PL #100 4502 GEORGETOWN PL #100 143 <br /> STOCKTON, CA 95207-6255 STOCKTON, CA 95207-6255 144, 145, 146 <br /> Contact phone 209-938-1238 209-938-1238 141 <br /> Contact email jenniferb@mcdsjc.com sumeraa@mcdsjc.com 142 <br /> Mail invoices to Account <br /> Program record [ ] HMBP [ ] SQG HW [ ] LOG HW [ ] RCRA HW New PR#: <br /> created [ ] Tiered permit [ ] APSA [ ] CaIARP [ ] UST 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: UV4 Date: �- it-, U7 <br /> Accounting. Reviewed by: VD Date: Clerical: [ ] File [ ] Relabel file [ ] Create new file <br /> [ A 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 PRO515486 JEFFREY WONG Active [ ] [ ] <br /> 1921 -HMBP-Regular-Primary Location PRO520888 HAZA SAEED Active [ ] [ ] <br /> 2399-UNIFIED PROGRAM FAC STATE SURCHARGE FEE PR0517791 RAYMOND BORGES Inactive [ ] [ ] <br /> ERSC-ELECTRONIC REPORTING STATE SURCHARGE FI PR0533053 not assigned Inactive [ ] [ ] <br />