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Date run 10/2/2014 8:28:43AK SAN JOIN COUNTY ENVIRONMENTAL HEAL J DEPARTMENT Report#5021 <br /> 12dn by Pagel <br /> Facility Information as of 10/2/2014 <br /> Record Selection Criteria: Facility ID FA0021105 <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, DON & NANCY <br /> Owner DBA MCDONALDS <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 FA0021105 10187755 <br /> Facility Name MCDONALDS #32074 <br /> Location 10623 TRINITY PKWY <br /> Stockton, CA 95219 <br /> Phone 209-478-0234 x <br /> Mailing Address 4502 GEORGETOWN PL #100 <br /> STOCKTON, CA 95207 <br /> care of Nancy Schrader <br /> Location Code 01 -STOCKTON Alt Phone <br /> BOB District 003 - BESTOLARIDES Fax <br /> APN 06602004 EMail: <br /> EMERGENCY NOTIFICATION CONTACT INFORMATION <br /> Contact Name NANCY J SCHRADER <br /> Title PARTNERMAUGHTER <br /> Day Phone 209-478-0234 <br /> Night Phone 209-351-1224 xNANCY <br /> ACCOUNTS RECEIVABLE FILE INFORMATION <br /> Account ID AR0038019 New Account ID: <br /> Mail Invoices to Facility Mail Invoices to: Owner / Facility / Account <br /> Account Name MCDONALDS #32074 (Circle One) <br /> Account Balance as of 10/2/2014: $0.00 (Circle One) <br /> Transfer to Active/InacNe <br /> PrograMElement and Description <br /> Record ID Employee ID and Name Status New Omen Delete <br /> 1625-RESTAURANT/BAR 51-100 SEATS PRO536738 EE0005362-NICHOLAS WIESEMAN Active Y N A 1 D <br /> 1921 -HMBP-Regular-Primary Location PRO536824 EE0000006-HAZA SAEED Active <br /> vl: Y N A I D <br /> Ell-ELECTRONIC REPORTING STATE SURCHARG PRO536837 <br /> BILLING and COMPLIANCE ACKNOWLEDGEMENT: I,the undersigned owner,operator or agent of same,acknowledge that all site,ander project speafic,PHSEHD houdy 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 win all applicable Ordinance Codes angor Standards and State anclor <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 /> REHS: Date_/_!_ Account out: Date <br /> COMMENTS: <br />