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SAN JOAQU OUNTY ENVIRONMENTAL HEALT EPARTMENT <br /> Changes to EnvisionConnect by CERS Integration Wizard <br /> Date run: 1/15/2015 <br /> Submitted on: 1/7/2015 9:19:53AM CERS ID: 10181015 <br /> Submitted by: Jennifer Bathe Email:jenniferb@mcdsjc.com Facility ID in CERS: FA0002906 <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, NANCY SCHRADER, DON 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 FA0002906 <br /> Facility name MCDONALDS#11159 MCDONALDS#11159 3 <br /> Site address 5308 PACIFIC AVE 5308 PACIFIC AVE 103 <br /> City Stockton STOCKTON 104 <br /> ZIP code 95207 95207 105 <br /> Facility phone 209-478-0234 (209)478-0234 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#11159 MCDONALDS#11159 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 Not Specified 209-938-1238 141 <br /> Contact emailjenniferb@mcdsjc.com 142 <br /> Mail invoices to ity t <br /> Program record [ ] HMBP [ ] SQG HW [ ] LQG HW [ ] RCRAHW 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 /> --------------------------------------- <br /> Accounting: Reviewed by: — Date: /0[jS 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 /> 1613-FOOD EST 501-1000 SQ FT W/O SEATING PRO162527 MARIBEL FLOHRSCHUTZ Active [ ] [ ] <br /> 1921 -HMBP-Regular-Primary Location PR0520994 HAZA SAEED Active [ ] [ ] <br /> 2399-UNIFIED PROGRAM FAC STATE SURCHARGE FEE PR0517644 RAYMOND BORGES Inactive [ ] [ ] <br /> ERSC-ELECTRONIC REPORTING STATE SURCHARGE FI PRO533111 not assigned Inactive [ ] [ ] <br />