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Date run 3/19/2015 4:10:10PA Report fl50Z1 <br /> SAN JOAWN COUNTY ENVIRONMENTAL HEAL1WEPARTMENT <br /> Run by Pagel <br /> Facility Information as of 3/19/201 <br /> Record Selection Criteria: Facility ID FA0001792 <br /> Make changes/corrections in RED ink. <br /> INFORMATION CHANGE(date) <br /> OWNERSHIP CHANGE(date) <br /> OWNER FILE INFORMATION Number of facilities for this owner: 28 SSN/Fed Tax ID : <br /> Owner ID OW0000446 New Owner ID <br /> Owner Name SCHRADER, CRAIG <br /> Owner DBA MCDONALD'S <br /> Owner Address 4502 GEORGETOWN PL 100 <br /> STOCKTON, CA 95207 <br /> Home Phone 209-478-0234 <br /> Work/Business Phone 209-938-1238 <br /> Mailing Address 4502 GEORGETOWN PL STE 100 <br /> STOCKTON, CA 95207 <br /> Care of REDARHCS INC <br /> FACILITY FILE INFORMATION <br /> Facility lD/CERS ID FA0001792 10180811 <br /> Facility Name MCDONALDS 25768 <br /> Location 2505 W MARCH LN <br /> STOCKTON, CA 95207 <br /> Phone 209-474-9811 x <br /> Mailing Address 4502 GEORGETOWN PL #100 <br /> STOCKTON, CA 95207 <br /> Care of Craig Schrader <br /> Location Code 01 -STOCKTON Alt Phone <br /> BOS District 002-MILLER, KATHERINE Fax <br /> APN 11222035 Entail: <br /> EMERGENCY NOTIFICATION CONTACT INFORMATION <br /> Contact Name CRAIG SCHRADER <br /> Title <br /> Day Phone 209-478-0234 <br /> Night Phone <br /> ACCOUNTS RECEIVABLE FILE INFORMATION <br /> Account ID AR0001792 New Account ID: <br /> Mail Invoices to Account Mail Invoices to: Owner / Facility / Account <br /> Account Name MCDONALDS 25768 (Circle One) <br /> Account Balance as of 3/19/2015: $0.00 <br /> (Circle One) <br /> Transfer to Active/Inaclve <br /> Program/Element and Description Record ID Employee ID and Name status New Omen Delete <br /> 1625-RESTAURANT/BAR 51-100 SEATS PRO160118 EE0006213-VIDAL PEDRAZA Active Y N A I D <br /> 1921 -HMBP-Regular-Primary Location PRO521167 EE0000006-HAZA SAEED Active Y N A I D <br /> 2224-HAZ MAT BUSINESS PLAN AUTHORIZATION PRO513464 EE0000000-HAZ MAT SJC OES Inactive Y N A I D <br /> 2399-UNIFIED PROGRAM FAC STATE SURCHARGE F PR0511176 EE0000000-HAZ MAT SJC OES Inactive Y N A I D <br /> ERSC-ELECTRONIC REPORTING STATE SURCHARG PRO531329 Inactive Y N A I D <br /> BILLING and COMPLIANCE ACKNOWLEDGEMENT: I,the undersigned owner,operator or agent of some,acknowledge that all site,ander project specific,PHS/EHD hourly charges associated with this facility <br /> or activity,will be billed to the party identified as the OWNER on this form. I also certify that all operations will be performed in accordance with all applicable Ordinance Codes and/or Standards and State and'or <br /> Federal Laws. <br /> APPLICANT'S SIGNATURE: Date <br /> Program Records to be TRANSFERED: '$25.00= Amount Paid Date <br /> Water System to be TRANSFERED: Amount Paid Date <br /> Payment Type Check Number Received by <br /> REFS: Date / /_ Account out: Date_/ / <br /> COMMENTS: <br />