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SAN JOAQUIN COUNTY ENVIRONMENTAL HEALTH DEPARTMENT <br />Changes to EnvisionConnect by CERS Integration Wizard <br />Date run: 5/5/2017 <br />Submitted on: 3/2/2017 8:12:10AM CERS ID: 10725922 <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 />OW0022469 <br />City of Lodi <br />PO BOX 3006 <br />Lodi, CA 95240 <br />209-333-6800 <br />FACILITY FILE INFORMATION <br />Facility ID <br />FA0024002 <br />Facility name <br />Lodi City Well #10C <br />Site address <br />17700 N Guild Rd <br />City <br />Lodi <br />ZIP code <br />95240 <br />Facility phone <br />209-333-6800 <br />Facility mailing address 1331 S. Ham Ln <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 />2093336800 112 <br />Lodi City Well #10C 3 <br />17700 N Guild Rd 103 <br />Lodi 104 <br />95240 105 <br />2093336800 102 <br />1331 S. Ham Ln 108a <br />Lodi, CA 95240 108b, 108c, 1o8d <br />City of Lodi well 10C <br />Lodi, CA 95240 <br />BILLING INFORMATION <br />143 <br />Contact name <br />City of Lodi well 10C <br />Address <br />1331 S. Ham Ln. <br />Lodi, CA 95205 <br />Contact phone <br />209-333-6800 <br />Contact email <br />Mail invoices to <br />Account <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 />2093336800 112 <br />Lodi City Well #10C 3 <br />17700 N Guild Rd 103 <br />Lodi 104 <br />95240 105 <br />2093336800 102 <br />1331 S. Ham Ln 108a <br />Lodi, CA 95240 108b, 108c, 1o8d <br />City of Lodi well 10C <br />140 <br />1331 S. Ham Ln. <br />143 <br />Lodi, CA 95205 <br />144, 145, 146 <br />2093336800 <br />141 <br />142 <br />Program record [%] HMBP [ ] SQG HW [ ] LQG HW [ ] RCRA HW <br />created [ ] Tiered permit [ ] APSA [ ] CalARP [ ] UST <br />New PR#: _ <br />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 by: /)-v--\ �3--- Date: 5-547 <br />------------------------------------------------- <br />Accounting: Reviewed by: bb Date: �! (n I Clerical: [ ] File [ ] Relabel file [ ] Create new file <br />[vj billed [}' Surcharge verified By: Date: <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 PR0541853 JAMIE LIMA Active [ I [ I <br />kle-t l d L -WI �4'417�5 L C".X ptq'�f'tw. �r9r-• C-26 5".6')*w` , aM — <br />