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Ask <br /> Date run 615/2015 10:16:46AM S OAQUIN COUNTY ENVIRONMENTAL .ALTH DEPARTMENT Report 95021 <br /> Run by Pagel <br /> Facility Information as of 615/2015 <br /> Record Selection Criteria: Facility ID FA0013364 <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: 26 SSN 1 Fed Tax ID <br /> Owner ID OW0000446 New Owner ID <br /> Owner Name SCHRADER, DON & NANCY <br /> Owner DBA MCDONALD'S <br /> OwnerAddress 4502 GEORGETOWN iPL 100 <br /> STOCKTON, CA 95207 <br /> Home Phone 209-78-0234 <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 1 CERS ID FA0013364 10184353 <br /> Facility Name MCDONALDS#25489 <br /> Location 322 S CENTER ST <br /> STOCKTON, CA 95203 <br /> Phone 209-946-4075 <br /> Mailing Address 4502 GEORGETOWN PL #100 <br /> STOCKTON, CA 95207 <br /> Care of <br /> Location Code 01 - STOCKTON Alt Phone <br /> BOS District 003- BESTOLARIDES, STEVE Fax <br /> APN 14906111 Entail: <br /> EMERGENCY NOTIFICATION CONTACT INFORMATION <br /> Contact Name <br /> Title <br /> Day Phone 209-946-4075 <br /> Night Phone <br /> ACCOUNTS RECEIVABLE FILE INFORMATION <br /> Account ID AR0022230 New Account ID: <br /> Mail Invoices to Facility Mail Invoices to: Owner I Facility I Account <br /> Account Name MCDONALDS#25489 (Circle One) <br /> Account Balance as of 61512015: $323.00 <br /> (Circle One) <br /> Transfer to ActiveAnactve <br /> ProgramfElement and Description Record ID Employee ID and Name Status New Owner? Delete <br /> 1625-RESTAURANT/BAR 51-100 SEATS PR0517353 EE0003361 -MARIBEL FLOHRSCHUTZ Active Y N A I D <br /> 1921 -HMBP-Reqular-Primary Location PR0537267 EE0009817-ROBERT LOPEZ Active Y N A I D <br /> BILLING and COMPLIANCE ACKNOWLEDGEMENT: I,the undersigned owner,operator or agent of same,acknowledge that all site,andlor project specific,PHSfLHD hourly 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 with all applicable Ordinance Codes and/or Standards and State andior <br /> Federal Laws. <br /> APPLICANT'S SIGNATURE: Date 1 1 <br /> Program Records to be TRANSFERED: $25.00= Amount Paid Date I I <br /> Water System to be TRANSFERED: Amount Paid Date ! l <br /> Payment Type Check Number Received by <br /> EHD Staff: Date I I Account out: Date ! I <br /> COMMENTS: <br /> Invoice#: <br />