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SAN JOAQUI. -OUNTY ENVIRONMENTAL HEALT tPARTMENT <br /> Changes to EnvisionConnect by CERS Integration Wizard <br /> Date run: 8/11/2014 <br /> Submitted on: 7/22/2014 4:33:20PM CERS ID: 10187117 <br /> Submitted by: Dameon Flores Email: dflores@ci.lathrop.ca.us Facility ID in CERS: FA0019218 <br /> Information prior to CIW processing Information after CIW processing CERS <br /> OWNER INFORMATION (current EC database) (current submittal) field <br /> Owner ID OW0015531 <br /> Owner name CITY OF LATHROP CITY OF LATHROP 111 <br /> Mailing address 390 TOWNE CENTRE DR 390 TOWNE CENTRE DR 113 <br /> LATHROP, CA 95330 LATHROP, CA 95330 114, 115,116 <br /> Work phone 209-941-7200 (209) 941-7200 112 <br /> FACILITY FILE INFORMATION <br /> Facility ID FA0019218 <br /> Facility name LATHROP WELL#9 LATHROP WELL#9 3 <br /> Site address 17550 SHIDELER PKWY 17550 SHIDELER PKWY 103 <br /> City LATHROP LATHROP 104 <br /> Zip code 95330 95330 105 <br /> Facility phone 209-941-7200 (209) 941-7430 102 <br /> Facility mailing address 390 TOWNE CENTER DR 390 TOWNE CENTRE DR 108a <br /> LATHROP, CA 95330 LATHROP, CA 95330 108b,108c,108d <br /> BILLING INFORMATION <br /> Contact name LATHROP WELL#9 r941-7430 <br /> 140 <br /> Address 390 TOWNE CENTER DR DR 143 <br /> LATHROP, CA 95330 144, 145, 146 <br /> Contact phone 209-941-7200 141 <br /> Contact email 142 <br /> Mail invoices to Facility <br /> Program record [ ] HMBP [ ] SQG HW [ ] LQG HW [ ] RCRA HW New PR#: <br /> created [ ] Tiered permit [ ] APSA [ ] CalARP [ ] 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 <br /> V-4--i by: ' Date: �'((-It 1 <br /> Accounting: Reviewed by: /��' Date: Clerical:,�,<File [ ] Relabel file [ j Create new file <br /> -- — [ ) Acc 'led [ ] Surchar By: Date: <br /> ACTIVE PROG AM RECORDS PRIOR TO PROCESSING THROUGH CIW <br /> Program Element and Description Record ID Employee name Status Reactivated Inactivated <br /> 1926-HMBP-Unstaffed Network Location PR0537195 MICHAEL PARISSI Active [ ] [ ] <br /> 2840-AST EXEMPT FAC <1,320 GAL PRO528589 THUY TRAN Inactive [ ] [ ] <br />