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SAN JOAQUIN COUNTY ENVIRONMENTAL HEALTH DEPARTMENT <br />Changes to EnvisionConnect by CERS Integration Wizard <br />Date run: 1/19/2017 <br />Submitted on: 1/10/2017 <br />Submitted by: George Montross <br />OWNER INFORMATION <br />Owner ID <br />Owner name <br />Mailing address <br />Work phone <br />3:06:06PM <br />Email: gmontross@ci.manteca.ca.us <br />Information prior to CIW processing <br />(current EC database) <br />Number of Facilities for this Owner : 39 <br />OW0000353 <br />City of Manteca - Fleet Division <br />1001 W Center St <br />Manteca, CA 95337 <br />209-456-8450 <br />FACILITY FILE INFORMATION <br />Facility ID <br />FA0022091 <br />Facility name <br />Manteca Well #27 <br />Site address <br />985 W Lathrop Rd <br />City <br />Manteca <br />ZIP code <br />95336 <br />Facility phone <br />209-456-8460 <br />Facility mailing address 1001 W Center St <br />Manteca, CA 95337 <br />BILLING INFORMATION <br />Contact name <br />Address <br />Contact phone <br />Contact email <br />Mail invoices to <br />Manteca Well #27 <br />1001 W Center St <br />Manteca, CA 95337 <br />209-456-8460 <br />Account <br />CERS ID: 10413250 <br />Facility ID in CERS: FA0022091 <br />Information after CIW processing CERS <br />(current submittal) field <br />7 1 /,Fj l 04&aC u- � 111 <br />1001 W Center St 113 <br />Manteca, CA 95337 114, 115, 116 <br />209-456-8460 112 <br />Manteca Well #27 3 <br />985 W Lathrop Rd 103 <br />Manteca 104 <br />95336 105 <br />209-456-8460 102 <br />1001 W Center St 108a <br />Manteca, CA 95337 108b, 108c,108d <br />Manteca Well #27 140 <br />1001 W Center St 143 <br />Manteca, CA 95337 144, 145, 146 <br />209-456-8460 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: Date: <br />-------------------------------------------------- <br />Accounting: Reviewed by: L46 Date: 11;0Ii7 Clerical: [ ] File [ ] Relabel file [ ] Create new file <br />[ ] 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 0 chem units PR0538231 NICHOLAS LOEHRER Active I I I I <br />