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SAN JOAQU- OUNTY ENVIRONMENTAL HEALT EFARTMENT <br /> Changes to EnvisionConnect by CERS Integration Wizard Date run: 6/1/2015 <br /> Submitted on: 5/28/2015 11:31:04AM CERS ID: 10180811 <br /> Submitted by: SumeraAwan 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) (current submittal) field <br /> Owner ID OW0000446 0k) 0 o 19e2' 1 <br /> Owner name SCHRADER, DON & NANCY Craig Schrader 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 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 209474-9811 (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 GEORGETOWN PL #100 143 <br /> STOCKTON, CA 95207 STOCKTON, CA 95207 144, 145, 146 <br /> Contact phone 209-938-1238 209-938-1238 141 <br /> Contact email sumeraa@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 [ ] CalARP [ ] 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: Date: <br /> Accounting: Reviewed by: tf5 Date: 090/ Clerical: [ ] File [ ] Relabel file [ ] Create new file <br /> [ ] Acct billed r 1 c c�ti�c�e��e�f d 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 PRO160118 VIDAL PEDRAZA Active [ ] [ ] <br /> 1921 -HMBP-Regular-Primary Location PRO521167 HAZA SAEED Active [ ] [ ] <br /> 2399-UNIFIED PROGRAM FAC STATE SURCHARGE FEE PRO511176 HAZ MAT SJC DES Inactive [ ] [ ] <br /> ERSC-ELECTRONIC REPORTING STATE SURCHARGE FI PR0531329 not assigned Inactive [ ] [ ] <br />