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SAN JOAQUIN COUNTY ENVIRONMENTAL HEALTH DEPARTMENT <br /> Changes to EnvisionConnect by CERS Integration Wizard Date run: 12/2/2016 <br /> Submitted on: 11/29/2016 8:29:08AM CERS ID: 10180701 <br /> Submitted by: SumeraAwan Email: sumeraa@mcdsjc.com Facility ID in CERS: FA0001096 <br /> Information prior to CIW processing Information after CIW processing CERS <br /> OWNER INFORMATION (current EC database) (current submittal) field <br /> Number of Facilities for this Owner: 11 / <br /> Owner ID OW0000446 d W OD <br /> Owner name SCHRADER, DON & NANCY - SCHRADER, CRAIG 111 <br /> Mailing address 4502 GEORGETOWN PL STE 100 4502 GEORGETOWN PL STE 100 113 <br /> STOCKTON, CA 95207 STOCKTON, CA 95207 114, 115, 116 <br /> Work phone 209-938-1238 209-938-1238 112 <br /> FACILITY FILE INFORMATION <br /> Facility ID FA0001096 <br /> Facility name MCDONALDS#11797 MCDONALDS#11797 3 <br /> Site address 1049 E MARCH LN 1049 E MARCH 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,load <br /> BILLING INFORMATION <br /> Contact name MCDONALDS#11797 MCDONALDS#11797 140 <br /> Address 4502 GEORGETOWN PL #100 4502 Gerorgetown PL 143 <br /> STOCKTON, CA 95207-6255 STOCKTON, CA 95207 144, 145, 146 <br /> Contact phone 209-938-1295 2099381295 141 <br /> Contact email madisonh@mcdsjc.com amandai@mcdsjc.com 142 <br /> Mail invoices to Account <br /> Program record [ ] HMBP [ ] SQG HW [ ] LQG 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: vv� Date: a" a" 1 �0 <br /> Accounting: Reviewed by: b6 Date: 12-14O b IP Clerical: [ ] File [ ] Relabel file [ ] Create new file <br /> [ ] Acct billed [ ] Surcharge verified By: Date: <br /> - -- ------ - - - - <br /> ACTIVE PROGRAM RECORDS PRIOR TO PROCESSING THROUGH CIW <br /> Record ID Employee name Status Reactivated Inactivated <br /> 1625-RESTAURANT/BAR 51-100 SEATS PRO162843 JEFFREY WONG Active [ ] [ ] <br /> 1919-HMBP-0O2 Only Food Facility 1 chem units PRO520735 JEFFREY WONG Active [ ] [ ] <br /> 2224-HAZ MAT BUSINESS PLAN AUTHORIZATION PRO513477 HAZ MAT SJC DES Inactive [ ] [ ] <br /> 2399-UNIFIED PROGRAM FAC STATE SURCHARGE FEE PRO511189 HAZ MAT SJC DES Inactive [ ] [ ] <br /> ERSC-ELECTRONIC REPORTING STATE SURCHARGE FI PRO533275 not assigned Inactive [ ] [ ] <br /> pl e ad -'f6 Ute' , <br />