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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 3:52:38PM <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 />OW0022495 <br />City of City <br />PO Box 3006 <br />Lodi, CA 95240 <br />209-333-6800 <br />FACILITY FILE INFORMATION <br />Facility ID <br />FA0024022 <br />Facility name <br />Lodi City Well #20 <br />Site address <br />2126 W Kettleman Ln <br />City <br />Lodi <br />ZIP code <br />95242 <br />Facility phone <br />209-333-6800 <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 />CERS ID: 10729039 <br />Facility ID in CERS: incorrect <br />Information after CIW processing CERS <br />(current submittal) field <br />City of y 111 <br />PO Box 3006 113 <br />Lodi, CA 95240 114, 115, 116 <br />209 333 6800 112 <br />Lodi City Well #20 3 <br />2126 W Kettleman Ln 103 <br />Lodi 104 <br />95242 105 <br />209 333 6800 102 <br />1331 S Ham Ln 108a <br />Lodi, CA 95240 108b, 108c, 1084 <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 [fl 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: Pg -- Date: 5�q —[ -7 <br />Accounting: Rev ed by: 1A.� Date: � f / �% Clerical: [ ] File [ ] Relabel file [ ] Create new file <br />[V Acct 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 PR0541883 JAMIE LIMA Active I I I I <br />M&L✓ 0w4)Qj' `-4[-j� I any �Vj9 rani Ck" Per GC R7 -�ASn"AA(A' Pov, <br />[U"'2qa-r�Vq <br />