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Date mn 3/19/2015 11:44:04A1 SAN JOA&N COUNTY ENVIRONMEN'T'AL HEALfPEPARTMENT <br /> Report#5021 <br /> Run by Pagel <br /> Facility Information as of 3119/2015 <br /> Record Selection.Criteria: Facility ID FA0002906 <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 ID/CERS ID FA0002906 10181015 <br /> Facility Name MCDONALDS#11159 <br /> Location 5308 PACIFIC AVE <br /> STOCKTON, CA 95207 <br /> Phone 209-478-0234 x <br /> Mailing Address 4502 GEORGETOWN PL #100 <br /> STOCKTON, CA 95207 <br /> Care of Don Schrader <br /> Location Code 01 -STOCKTON Alt Phone <br /> BOS District 002- MILLER, KATHERINE Fax <br /> APN 10224019 EMail: <br /> EMERGENCY NOTIFICATION CONTACT INFORMATION <br /> Contact Name REDARHCS MANAGEMENT COMPA <br /> Title <br /> Day Phone <br /> Night Phone <br /> ACCOUNTS RECEIVABLE FILE INFORMATION <br /> Account ID AR0002467 New Account ID: <br /> Mail Invoices to Account Mail Invoices to: Owner / Facility / Account <br /> Account Name MCDONALDS#11159 (Circle One) <br /> Account Balance as of 3/19/2015: $0.00 <br /> (Circle One) <br /> Transfer to ActivellnacNe <br /> PrograrnlElement and Description Record ID Employee ID and Name Status New Owner? Delete <br /> 1613-FOOD EST 501-1000 SO FT W/O SEATING PRO162527 EE0003361 -MARIBEL FLOHRSCHUTZ Active Y N A I D <br /> 1921 -HMBP-Reqular-Primary Location PRO520984 EE0000006-HAZA SAEED Active Y N A I D <br /> 2224-HAZ MAT BUSINESS PLAN AUTHORIZATION PR0517643 EE0000000-HAZ MAT SJC DES Inactive Y N A I D <br /> 2399-UNIFIED PROGRAM FAC STATE SURCHARGE F PR0517644 EE0000149-RAYMOND BORGES Inactive Y N A I D <br /> ERSC-ELECTRONIC REPORTING STATE SURCHARG PRO533111 Inactive Y N A I D <br /> BILLING and COMPLIANCE ACKNOWLEDGEMENT: I,the undersigned owner,operator or agent of same,acknowledge that all site,andior prolecl specific,PHSIEHD hourly charges associated with Nis 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 ander <br /> Federal Laws. <br /> APPLICANTS 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 /> RENS: Date /_/ Account out: Date <br /> COMMENTS: <br />