Laserfiche WebLink
SAN JOAQUIN`COUNTY ENVIRONMENTAL HEALTI-MEPARTMENT <br /> Changes to EnvisionConnect by CERS Integration Wizard Date run: 7/11/2014 <br /> Submitted on: 1/24/2014 10:36:09AM CERS ID: 10450999 <br /> Submitted by: Dori Longworth Email: dlongworth@westerndental.com Facility ID in CERS: <br /> Information prior to CIW processing Information after CIW processing CERS <br /> OWNER INFORMATION (current EC database) (current submittal) field <br /> Owner ID OW0018236 <br /> Owner name Western Dental Services, Inc Western Dental Services, Inc 111 <br /> Mailing address 530 South Main St. % 530 South Main St. 113 <br /> Orange, CA 92868 Orange, CA 92868 11a, 115, its <br /> Work phone 714-480-3000 1/ 714-480-3000 112 <br /> FACILITY FILE INFORMATION <br /> Facility ID FA0022158 6e <br /> Facility name Western Dental Western Dental 3 <br /> Site address 320 South Cherokee Lane 320 South Cherokee Lane 103 <br /> City Lodi Lodi 104 <br /> Zip code 95240 95240 105 <br /> Facility phone 209-366-7970 209-366-7970 102 <br /> Facility mailing address 530 South Main St. 530 South Main St. 108a <br /> Orange, CA 92868 Orange, CA 92868 10eb,Mc,coed <br /> BILLING INFORMATION <br /> Contact name Linda Cueva Linda Cueva 140 <br /> Address 530 South Main St. 530 South Main St. 143 <br /> Orange, CA 92868 Orange, CA 92868 144, 145, 145 <br /> Contact phone 714-571-3574 714-571-3574 141 <br /> Contact email Icueva@westerndental.com Icueva@westerndental.com 142 <br /> Mail invoices to Facility <br /> Program record HMBP [ ] SQG HW I ] LQG HW [ ] RCRA HW New PRM d 2� <br /> created ] Tiered permit [ ] APSA [ ] CalARP [ ] UST New PE: <br /> Assigned to: vela d,050- <br /> Please bill: full calendar year [ J prorate this calendar year [ ] next calendar year [ ] exempt from billing <br /> Processed through CERS Integration Wizard by: _Date: <br /> Accounting: Rev wed by: _t$Date: 2L `� Clerical: [ ] File [ ] Relabel file [ ] Create new file <br /> [[,j Acct billed [ ] Surcharge verified By: Date: <br /> -------------------------------------------------- <br /> ACTIVE PROGRAM RECORDS PRIOR TO PROCESSING THROUGH CIW <br /> Program Element and Description Record ID Employee name Status Reactivated Inactivated <br /> 2220-SM HW GEN<5 TONSNR PR0538341 ARIS VELOSO Alive [ ] [ I <br />