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Date run 4/6/2015 11:48:11AM SAN JOIN COUNTY ENVIRONMENTAL HEAL(ODEPARTMENT Report#5021 <br /> Run by Pagel <br /> Facility Information as of 4I6I2015 <br /> Record Selection Criteria: Facility ID FA0012283 <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 TaxlD : <br /> Owner ID OW0000446 New Owner ID <br /> Owner Name SCHRADER, CRAIG <br /> Owner DBA MCDONALD'S <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 ID/CERS ID FA0012283 10184179 <br /> Facility Name MCDONALDS#23653 <br /> Location 1236 W YOSEMITE AVE <br /> MANTECA, CA 95336 <br /> Phone 209-239-3379 x <br /> Mailing Address 4502 GEORGETOWN PL #100 <br /> STOCKTON, CA 95207-6255 <br /> care of Craig Schrader <br /> Location Code 04- MANTECA Alt Phone <br /> BOS District 005 - ELLIOTT, BOB Fax <br /> APN 22208024 EMail: <br /> EMERGENCY NOTIFICATION CONTACT INFORMATION <br /> Contact Name SCHRADER, CRAIG M <br /> Title <br /> Day Phone <br /> Night Phone <br /> ACCOUNTS RECEIVABLE FILE INFORMATION <br /> Account ID AR0019939 New Account ID: <br /> Mail Invoices to Account Mail Invoices to: Owner / Facility / Account <br /> Account Name MCDONALDS#23653 (Circle One) <br /> Account Balance as of 4/6/2015: $0.00 <br /> (Circle One) <br /> Transferto Activelinacive <br /> Program(Element and Description Record ID Employee ID and Name Status New Owner? Delete <br /> 1626-RESTAURANT/BAR 101 +SEATS PRO515685 EE0005366-LISA MEDINA Active Y N A I D <br /> 1921 -HMBP-Regular-Primary Location PRO620917 EE0002474-MICHAEL PARISSI Active Y N A 1 D <br /> 2224-HAZ MAT BUSINESS PLAN AUTHORIZATION PRO515855 EE0000000-HAZ MAT SJC OES Inactive Y N A I D <br /> 2399-UNIFIED PROGRAM FAC STATE SURCHARGE F PR0516856 EE0009903-DOUG WILSON Inactive Y N A I D <br /> ERSC-ELECTRONIC REPORTING STATE SURCHARG PRO533772 Inactive Y N A I D <br /> BILLING and COMPLIANCE ACKNOWLEDGEMENT: 1,the undersigned owner,operator or agent of same,acknowledge that all site,andor ProjeG specific,PHSEHD hourly charges associated with this facility <br /> or activity will be billed to the party identified as the OWNER on this forth. I also certify that all operations will be performed in accordance with all applicable Ordinance Codes and/or Standards and State and/or <br /> Federal Laws. <br /> APPLICANT'S 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 /> RENS: Date /_/_ Account out: Date <br /> COMMENTS: <br />