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SAN JOAQUI OUNTY ENVIRONMENTAL HEALTH APARTMENT <br /> Changes to EnvisionConnect by CERS Integration Wizard Date run: 6/1/2015 <br /> Submitted on: 5128/2015 11:59:57AM CERS ID: 10184179 <br /> Submitted by: SumeraAwan Email: sumeraa@mcdsjc.com Facility ID in CERS: FA0012283 <br /> Information prior to CIW processing Information after CIW processing CERS <br /> OWNER INFORMATION (current EC database) (current submittal) field <br /> Owner ID OW0000446 b(v 00) go-i` <br /> Owner name SCHRADER, CATHY SCHRADER, CRAIG 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 FA0012283 <br /> Facility name McDONALDS#23653 McDONALDS#23653 3 <br /> Site address 1236 W YOSEMITE AVE 1236 W YOSEMITE AVE 103 <br /> City MANTECA MANTECA 104 <br /> ZIP code 95336 95336 105 <br /> Facility phone 209-239-3379 (209) 239-3379 102 <br /> Facility mailing address 4502 GEORGETOWN PL #100 4502 GEORGETOWN PL #100 108a <br /> STOCKTON, CA 95207-6255 STOCKTON, CA 95207-6255 108b,mac,load <br /> BILLING INFORMATION <br /> Contact name McDONALDS#23653 McDONALDS#23653 140 <br /> Address 4502 GEORGETOWN PL #100 4502 GEORGETOWN PL #100 143 <br /> STOCKTON, CA 95207-6255 STOCKTON, CA 95207-6255 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 Account <br /> Program record [ ] HMBP [ ] SQG HW [ ] LOG HW [ ] RCRA HW New PR#: <br /> created [ ] Tiered permit [ ] APSA [ ] CaIARP [ ] 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: �t'g 1S Clerical: [ ] File ( ] Relabel file [ ] Create new file <br /> [ ct By: Date: <br /> ACTIVE PROGRAM RECORDS PRIOR TO PROCESSING THROUGH CIW <br /> Program Element and Description Record ID Employee name Status Reactivated Inactivated <br /> 1626-RESTAURANT/BAR 101 +SEATS PR0515685 KADEANNE LINHARES Active [ 1 [ 1 <br /> 1921 -HMBP-Regular-Primary Location PR0520917 MICHAEL PARISSI Active <br /> 2399-UNIFIED PROGRAM FAC STATE SURCHARGE FEE PRO515856 DOUG WILSON Inactive [ ] [ 1 <br /> ERSC-ELECTRONIC REPORTING STATE SURCHARGE FI PR0533772 not assigned Inactive [ 1 [ 1 <br />