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SAN JOAQUIN COUNTY ENVIRONMENTAL HEALTH DEPARTMENT <br />Changes to EnvisionConnect by CERS Integration Wizard <br />Date run: 6/14/2017 <br />Submitted on: 6/12/2017 11:27:08AM <br />CERS ID: 10564882 <br />Submitted by: Mary Anne Strojan Email: farmingtonwater@velociter.net <br />Facility ID in CERS: <br />FA0022404 <br />Information prior to CIW processing <br />Information after CIW processing <br />CERS <br />OWNER INFORMATION (current EC database) <br />(current submittal) <br />field <br />Number of Facilities for this Owner.- 3 <br />Owner ID OW0011717 <br />Owner name Farmington Water Company <br />Farmington Water Company <br />111 <br />Mailing address P.O. Box 55 <br />P.O. Box 77 <br />113 <br />Farmington, CA 95230 <br />Farmington, CA 95230 <br />114, 115, 116 <br />Work phone 209-886-5346 <br />209-886-5346 <br />112 <br />FACILITY FILE INFORMATION <br />Facility ID FA0022404 <br />Facility name FARMINGTON WATER WELL 4 <br />Farmington Water Well 4 <br />3 <br />Site address 25335 E HWY 4 <br />25335 E. Hwy 4 <br />103 <br />City FARMINGTON <br />Farmington <br />104 <br />ZIP code 95230 <br />95230 <br />105 <br />Facility phone 209-610-5297 <br />209-610-5297 <br />102 <br />Facility mailing address P.O. Box 77 <br />P.O. Box 77 <br />108a <br />Farmington, CA 95230 <br />Farmington, CA 95230 <br />108b, 108c, 108d <br />BILLING INFORMATION <br />Contact name FARMINGTON WATER WELL 4 <br />Farmington Water Company <br />140 <br />Address P.O. Box 77 <br />P.O. Box 77 <br />143 <br />Farmington, CA 95230 <br />Farmington, CA 95230 <br />144, 145, 146 <br />Contact phone Not Specified <br />209-886-5346 <br />141 <br />Contact email <br />farmingtonwater@velociter.net <br />142 <br />Mail invoices to Account <br />Program record [ ] HMBP [ ] SQG HW [ ] LQG HW [ <br />] RCRA HW New PR#: <br />created [ ] Tiered permit [ ] APSA [ ] CaIARP [ <br />] UST New PE: <br />Assigned to: <br />Please bill: [ ] full calendar year [ ] prorate this calendar year <br />[ ] next calendar year [ ] exempt from billing <br />Integration Wizard �`'� Date: _(y,17 <br />Processed through CERS by: <br />1 <br />file <br />file <br />Accounting: Reviewed by: Date: Clerical: <br />[ ] File [ ] Relabel [ ] Create <br />new <br />[ ] Acct billed [ ] Surcharge verified <br />By: Date: <br />ACTIVE PROGRAM RECORDS PRIOR TO PROCESSING THROUGH CIW <br />Record ID Employee <br />name Status Reactivated <br />Inactivated <br />1920 - HMBP-Common Materials 1 chem units PR0539096 JAMIE LIMA <br />Active I I <br />I I <br />