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SAN JOAQU OUNTY ENVIRONMENTAL HEALT PARTMENT <br /> Changes to EnvisionConnect by CERS Integration Wizard Date run: 1/14/2015 <br /> Submitted on: 1/7/2015 8:19:25AM CERS ID: 10180811 <br /> Submitted by: Jennifer Bathe Email:jenniferb@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 <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 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,1080,108d <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 J 142 <br /> Mail invoices to F�ti y 1< <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 /> f ' <br /> Processed through CERS Integration Wizard by: ' Date: `T s- <br /> - --D-_-------- <br /> Accounting: Reviewed by: /� Date: -y L[ 1l J Clerical: ( ] File [ ] Relabel file [ ] Create new file <br /> [ ] Acct billed [ ] Surcharge verified 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-RESTAURANTIBAR 51-100 SEATS PRO160118 VIDAL PEDRAZA Active [ ] [ ] <br /> 1921 -HMBP-Regular-Primary Location PR0521167 HAZA SAEED Active [ ] [ ] <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 />