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SAN JOAQUIN COUNTY ENVIRONMENTAL HEALTH DEPARTMENT <br />Changes to EnvisionConnect by CERS Integration Wizard <br />Date run: 1/15/2016 <br />Submitted on: 1/11/2016 10:15:41AM CERS ID: 10413250 <br />Submitted by: George Montross Email: gmontross@ci.manteca.ca.us Facility ID in CERS: FA0022091 <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 : 39 <br />OW0000353 <br />MANTECA, CITY OF <br />1001 W CENTER ST <br />MANTECA, CA 95337 <br />209-456-8468 <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 <br />1001 W Center St <br />985 W Lathrop Rd <br />Manteca, CA 95337 <br />BILLING INFORMATION <br />104 <br />Contact name <br />Manteca Well #27 <br />Address <br />1001 W Center St <br />Manteca, CA 95337 <br />Contact phone <br />209-456-8460 <br />Contact email <br />Mail invoices to <br />Facility <br />Information after CIW processing CERS <br />(current submittal) field <br />7 1111A A&C kl 111 <br />1001 W Center St N D.� 113 <br />Manteca, CA 95337 114, 115, 116 <br />209-456-8460 112 <br />Manteca Well #27 <br />3 <br />985 W Lathrop Rd <br />103 <br />Manteca <br />104 <br />95336 <br />105 <br />209-456-8460 <br />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: t' ( S" < <o <br />---------------- <br />Accounting: Reviewed by: Date: I �/S �/ 4 Clerical: [ ] File [ ] Relabel file [ ] Create new file <br />[ ] Acct billed [ ] Surcharge verified By: Date: <br />ACTIVE PROGRAM RECORDS PRIOR TO PROCESSING THROUGH CIW <br />Program Element and Description Record ID Employee name Status Reactivated Inactivated <br />1926 - HMBP-Unstaffed Network Location PR0538231 NICHOLAS LOEHRER Inactive I I I I <br />