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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: 3/1/2017 2:59:55PM <br />Submitted by: Bill Cooper Email: bcooper@lodi.gov <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 />OW0022480 <br />City of Lodi <br />PO Box 3006 <br />Lodi, CA 95240 <br />209-333-6800 <br />FACILITY FILE INFORMATION <br />Facility ID <br />FA0024013 <br />Facility name <br />Lodi City Well #28 <br />Site address <br />2800 W Kettleman Ln <br />City <br />Lodi <br />ZIP code <br />95240 <br />Facility phone <br />209-333-6800 <br />Facility mailing address <br />1331 S HamLn <br />Lodi, CA 95240 <br />BILLING INFORMATION <br />Contact name <br />City of Lodi <br />Address <br />1331 S Ham Ln <br />Lodi, CA 95240 <br />Contact phone <br />209-333-6800 <br />Contact email <br />Mail invoices to <br />Account <br />CERS ID: 10729054 <br />Facility ID in CERS: incorrect <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 #28 3 <br />2800 W Kettleman Ln 103 <br />Lodi 104 <br />95240 105 <br />209 333 6800 102 <br />1331 S HamLn 108a <br />Lodi, CA 95240 108b, 108c, 108d <br />City of Lodi <br />140 <br />1331 S Ham Ln <br />143 <br />Lodi, CA 95240 <br />144, 145, 146 <br />209 333 6800 <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: [\gull calendar year [ ] prorate this calendar year [ ] next calendar year [ ] exempt from billing <br />Processed through CERS Integration Wizard by: 00 A, U-- Date: S �� <br />Accounting: Reviewed by: w Date: "'' Clerical: [ ] File [ ] Relabel file [ ] Create new file <br />[ ] _ _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 PR0541867 JAMIE LIMA p Active [ ] [ ] <br />c2�.,ner�+tc1(�-ill 4111 PO y/u,1--\ u`7 /)4�f �K5 , Di✓\ _ <br />�yul� ��1�73y <br />