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SAN JOAQUIN COUNTY ENVIRONMENTAL HEALTH DEPARTMENT Report# 5022 <br />Facility Information for CERS Comparison as of 10/24/2018 Date run: 10/24/2018 <br />CERS ID: 10180923 <br />OWNER INFORMATION Number of Facilities for this Owner: 2 <br />Owner ID <br />OW0015367 <br />Owner name <br />Bill Schaefer <br />Mailing address <br />596 Innocent Way <br />City <br />Copperopolis; CA 95228 <br />Work phone <br />559-313-5388 <br />FACILITY FILE INFORMATION <br />Facility ID <br />FA0002406 <br />Facility name <br />DEN NYS #445 <br />Site address <br />642 W CHARTER WAY <br />City <br />STOCKTON <br />ZIP code <br />95206 <br />Facility phone <br />559-313-5388 <br />Facility mailing address <br />596 Innocent Way <br />Active [ ] [ ] <br />Copperopolis, CA 95228 <br />BILLING INFORMATION <br />NICHOLAS WIESEMAN <br />Contact name <br />Bill Schaefer <br />Mailing address <br />596 Innocent Way <br />Copperopolis, CA 95228 <br />Contact phone <br />559-313-5388 <br />Contact email <br />bill@hotcakesinc.org <br />Mail invoices to <br />Account <br />Make changes/corrections in RED ink. <br />INFORMATION CHANGE (date) <br />OWNERSHIP CHANGE (date) <br />CERS <br />field ID <br />A 111 <br />113 <br />114, 115, 116 <br />112 <br />3 <br />103 <br />104 <br />105 <br />102 <br />108a <br />108b, 108c, 1084 <br />140 <br />143 <br />144, 145, 146 <br />141 <br />142 <br />EHDStaff:c� �� Date: <br />�j I I �?•O �� � <br />LINKED PROGRAM RECORDS <br />Record ID <br />Employee name <br />Current status Activate Inactivate <br />1626 - RESTAURANT/BAR 101 + SEATS <br />PRO161135 <br />LEYNA HUYNH <br />Active [ ] [ ] <br />1919 - HMBP-CO2 Only Food Facility 1 chem units <br />PRO636635 <br />LEYNA HUYNH <br />Active [ ] [ ] <br />2066 -MILK DISPENSER <br />PR0200253 <br />NICHOLAS WIESEMAN <br />Inactive [ ] [ ] <br />ERSC - ELECTRONIC REPORTING STATE SURCHARGE F PRO536842 <br />not assigned <br />Inactive [ ] [ ] <br />EHDStaff:c� �� Date: <br />�j I I �?•O �� � <br />