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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 2:28:18PM CERS ID: 10729036 <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 />OW0022494 <br />City of Lodi <br />PO box 3006 <br />Lodi, CA 95240 <br />209-333-6800 <br />FACILITY FILE INFORMATION <br />Information after CIW processing <br />(current submittal) <br />City of Lodi <br />PO box 3006 <br />Lodi, CA 95240 <br />209 333 6800 <br />CERS <br />field <br />111 <br />113 <br />114, 115, 116 <br />112 <br />Facility ID <br />FA0024021 <br />Facility name <br />Lodi City Well #19 <br />Lodi City Well #19 <br />3 <br />Site address <br />601 E Harney Ln <br />601 E Harney Ln <br />103 <br />City <br />Lodi <br />Lodi <br />104 <br />ZIP code <br />95242 <br />95242 <br />105 <br />Facility phone <br />209-333-6800 <br />209 333 6800 <br />102 <br />Facility mailing address <br />1331 S Ham Ln <br />1331 S Ham Ln <br />108a <br />Lodi, CA 95240 <br />Lodi, CA 95240 <br />108b, 108c, 1084 <br />BILLING INFORMATION <br />Contact name City of Lodi City of Lodi 140 <br />Address 1331 S Ham 1331 S Ham 143 <br />Lodi, CA 95240 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 [vf 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 Wizard by: �J, Date: <br />-------lel i ---- - --- ----- - - -- <br />Accounting: Reviewed by. � Date: Clerical: [ ] File [ ] Relabel file [ ] Create new file <br />[ cct billed [ urcharge 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 PRO541882 JAMIE LIMA Active I I I I <br />Oat,, ownQ 1 ����� k C"" CO b fi'l o,s flU Cc R5 yu6 rAr k . DO" R9— <br />