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AMIL <br /> SAN JOAQUI OUNTY ENVIRONMENTAL HEALTH PARTMENT <br /> Changes to EnvisionConnect by CERS Integration Wizard Date run: 6/1/2015 <br /> Submitted on: 5/28/2015 12:56:33PM CERS ID: 10187755 <br /> Submitted by: Sumera Awan Email: sumeraa@mcdsjc.com Facility ID in CERS: FA0021105 <br /> Information prior to CIW processing Information after CIW processing CERS <br /> OWNER INFORMATION (current EC database) (current submittal) field <br /> Owner ID OW0000446 DIJ D0 7/oa� <br /> Owner name SCHRADER. CATHY SCHRADER, NANCY 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 FA0021105 <br /> Facility name MCDONALDS #32074 MCDONALDS #32074 3 <br /> Site address 10623 TRINITY PKWY 10623 TRINITY PKWY 103 <br /> City STOCKTON STOCKTON 104 <br /> ZIP code 95219 95219 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 #32074 MCDONALDS #32074 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 jenniferb@mcdsjc.com sumeraa@mcdsjc.com 142 <br /> Mail invoices to Facility <br /> Program record [ ] HMBP [ ] SQG HW [ ] LOG HW [ ] RCRA HW New PRN: <br /> created [ ] Tiered permit [ ] APSA [ ] CaIARP [ ] UST New PE: <br /> Assigned to: <br /> Please bill: [ ] full calendar year [ j prorate this calendar year [ ] next calendar year [ ] exempt from billing <br /> Processed through CERS Integration Wizard by: Date: <br /> Accounting: Reviewed by: bf-? Date: V g K Clerical: [ ] File [ ] Relabel file [ ] Create new file <br /> [ ]� rte h llPd r 1 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-RESTAURANT/BAR 51-100 SEATS PR0536738 STEPHANIE RAMIREZ Active [ ] [ 1 <br /> 1921 -HMBP-Regular-Primary Location PR0536824 HAZA SAEED Active [ ] [ 1 <br /> ERSC-ELECTRONIC REPORTING STATE SURCHARGE FI PRO536837 not assigned Inactive [ ] [ 1 <br />