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SAN JOAQUIN COUNTY ENVIRONMENTAL HEALTH DEPARTMENT <br />Changes to EnvisionConnect by CERS Integration Wizard <br />Date run: 5/9/2017 <br />Submitted on: 3/1/2017 3:31:30PM CERS ID: 10729045 <br />Submitted by: Bill Cooper Email: bcooper@lodi.gov Facility ID in CERS: incorrect <br />OWNER INFORMATION <br />Owner ID <br />Owner name <br />Mailing address <br />Work phone <br />Information prior to CIW processing <br />(current EC database) <br />Number of Facilities for this Owner : 1 <br />OW0022497 <br />City of Lodi <br />PO Box 3006 <br />Lodi, CA 95240 <br />209-333-6800 <br />FACILITY FILE INFORMATION <br />Facility ID FA0024024 <br />Facility name Lodi City Well #26 <br />Site address 1020 Bridgetowne Dr <br />City Lodi <br />ZIP code 95242 <br />Facility phone 209-680-0 <br />Facility mailing address 1331 S Ham Ln <br />Lodi, CA 95240 <br />BILLING INFORMATION <br />Contact name City of Lodi <br />Address 1331 S Ham Ln <br />Lodi, CA 95240 <br />Information after CIW processing CERS <br />(current submittal) field <br />City of Lodi 111 <br />PO Box 3006 113 <br />Lodi, CA 95240 114, 115, 116 <br />209 333 6800 112 <br />LOdi City Well #26 <br />3 <br />1020 Bridgetowne Dr <br />103 <br />Lodi <br />104 <br />209 6800 (�0�1) 333-1o�S0o <br />102 <br />1331 S Ham Ln <br />108a <br />Lodi, CA 95240 <br />108b, 1o8c, 1o8d <br />City of Lodi 140 <br />1331 S Ham Ln 143 <br />Lodi, CA 95240 144, 145, 146 <br />Contact phone 209-333-6800 209 333 6800 141 <br />Contact email 142 <br />Mail invoices to Account <br />Program record [ HMBP [ ] SQG HW [ ] LQG 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 bDate: <br />Accounting: Reviewed by: t4J Date: 5/`0 / / Clerical: [ ] File [ ] Relabel file [ ] Create new file <br />[Qzkcct billed [ Surcharge verified By: Date: <br />------------------------------------------------ <br />ACTIVE PROGRAM RECORDS PRIOR TO PROCESSING THROUGH CIW <br />Record ID Employee name Status Reactivated Inactivated <br />1921 - HMBP-Regular-Primary Location 1 chem units PR0541885 JAMIE LIMA Active I I I I <br />�)aw c9w,ne/I i-uGl�'l�� I CkA 1034,x, 4(, Pe( L R5 �v�Ur^'.e�1 , Q(vj p�— <br />Llw-1 -2q -). &'-e9 <br />