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SAN JOAQUIN COUNTY ENVIRONMENTAL HEALTH DEPARTMENT <br /> Changes to EnvisionConnect by CERS Integration Wizard <br /> Date run: 12/2/2016 <br /> Submitted on: 11/29/2016 9:38:27AM CERS ID: 10180811 <br /> Submitted by: Sumera Awan Email: sumeraa@mcdsjc.com Facility ID in CERS: FA0001792 <br /> Information prior to CIW processing Information after CIW processing CERS <br /> OWNER INFORMATION (current EC database) l (current submittal) field <br /> Number of Facilities for this Owner: 11 <br /> Owner ID OW0012665 <br /> Owner name Craig Schrader Craig Schrader 111 <br /> Mailing address 4502 Georgetown Place 4502 GEORGETOWN PL STE 100 113 <br /> Stockton, CA 95207 STOCKTON, CA 95207 114, 115, 116 <br /> Work phone 209-478-0234 209-938-1238 112 <br /> FACILITY FILE INFORMATION <br /> Facility ID FA0001792 <br /> Facility name MCDONALDS 25768 MCDONALDS 25768 3 <br /> Site address 2505 W MARCH LN 2505 W MARCH LN 103 <br /> City STOCKTON STOCKTON 104 <br /> ZIP code 95207 95207 105 <br /> Facility phone 209-474-9811 (209) 474-9811 102 <br /> Facility mailing address 4502 GEORGETOWN PL #100 4502 GEORGETOWN PL #100 108a <br /> STOCKTON, CA 95207 STOCKTON, CA 95207 108b, 108c,108d <br /> BILLING INFORMATION <br /> Contact name MCDONALDS 25768 MCDONALDS 25768 140 <br /> Address 4502 GEORGETOWN PL #100 4502 Gerorgetown PL 4) a Q 143 <br /> STOCKTON, CA 95207 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 [ j SQG HW [ ] LOG HW [ ] RCRA HW New PR#: <br /> created [ ] Tiered permit [ ] APSA [ ] CalARP [ ] UST New PE: <br /> Assigned to: <br /> Please bill: [ ] full calendar year [ ] prorate t i calendar year [ ] next calendar year [ ] exempt from billing <br /> Processed through CERS Integration Wizard by: Date: Z <br /> ----- - ---- -y -- - - - -- [� [ — — - - [ ] <br /> Accountin Reviewed by: Date: �2/�/` 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 PRO160118 VIDAL PEDRAZA Active [ ] [ ] <br /> 1919-HMBP-0O2 Only Food Facility 1 chem units PRO521167 VIDAL PEDRAZA Active [ ] [ ] <br /> 2224-HAZ MAT BUSINESS PLAN AUTHORIZATION PRO513464 HAZ MAT SJC OES Inactive [ ] [ ] <br /> 2399-UNIFIED PROGRAM FAC STATE SURCHARGE FEE PR0511176 HAZ MAT SJC OES Inactive [ ] [ ] <br /> ERSC-ELECTRONIC REPORTING STATE SURCHARGE FI PR0531329 not assigned Inactive [ ] [ ] <br />