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SAN JOAQUIN COUNTY ENVIRONMENTAL HEALTH DEPARTMENT Changes to EnvisionConnect by CERS Integration Wizard Date run: 5/5/2017 Submitted on: 3/2/2017 9:03:44AM Submitted by: Bill Cooper Email: bcooper@lodi.gov CERS ID: 10729033 Facility ID in CERS: incorrect Information prior to CIW processing Information after CIW processing CERS OWNER INFORMATION (current EC database) (current submittal) field Number of Facilities for this Owner: 1 Owner ID OW0022481 Owner name City of Lodi City of Lodi 111 Mailing address PO Box 3006 PO Box 3006 113 Lodi, CA 95240 Lodi, CA 95240 114, 115, 116 Work phone 209-333-6800 209 333 6800 112 FACILITY FILE INFORMATION Facility ID FA0024014 Facility name Lodi City Well #18 Lodi City Well #18 3 Site address 200 W Century Blvd 200 W Century Blvd 103 City Lodi Lodi 104 ZIP code 95240 95240 105 Facility phone 209-333-6800 209 333 6800 102 Facility mailing address 1331 S Ham Ln 1331 S Ham Ln 108a Lodi, CA 95240 Lodi, CA 95240 108b, 108c, 108d BILLING INFORMATION Contact name City of Lodi City of Lodi 140 Address 1331 S Ham Ln 1331 S Ham Ln 143 Lodi, CA 95240 Lodi, CA 95240 144, 145, 146 Contact phone 209-333-6800 209 333 6800 141 Contact email 142 Mail invoices to Account Program record [VrHMBP [ ] SQG HW [ ] LQG HW [ ] RCRA HW New PR#: created [ ] Tiered permit [ ] APSA [ ] CaIARP [ ] UST New PE: Assigned to: Please bill: [vi -,full calendar year [ ] prorate this calendar year [ ] next calendar year (] exempt from billing Processed through CERS Integration Wizard by: do, P2 Date: 5-5-17 ---------------------------i Accounting: Reviewed by: Date. �A 1 Clerical: [ ] File [ ] Relabel file [ ] Create new file [l. Acct billed [Surcharge verified By: Date: --------------------------------------------------- ACTIVE PROGRAM RECORDS PRIOR TO PROCESSING THROUGH CIW Record ID Employee name Status Reactivated Inactivated 1921 - HMBP-Regular-Primary Location 1 chem units PR0541869 JAMIE LIMA Active I I I I U111V*_ ;Lq;�;74v