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SAN JOAQUIN COUNTY ENVIRONMENTAL HEALTH DEPARTMENT Changes to EnvisionConnect by CERS Integration Wizard Date run: 5/5/2017 Submitted on: 3/2/2017 9:41:54AM CERS ID: 10729024 Submitted by: Bill Cooper Email: bcooper@lodi.gov Facility ID in CERS: incorrect OWNER INFORMATION Owner ID Owner name Mailing address Work phone Information prior to CIW processing (current EC database) Number of Facilities for this Owner: 1 OW0022479 City of Lodi PO Box 3006 Lodi, CA 95240 209-333-6800 FACILITY FILE INFORMATION Facility ID FA0024012 Facility name Lodi City Well #15 Site address 830 N Lower Sacramento Rd City Lodi ZIP code 95242 Facility phone 209-333-6800 Facility mailing address 1331 S Ham Ln Lodi, CA 95240 BILLING INFORMATION Contact name City of Lodi Address 1331 S Ham Ln Lodi, CA 95240 Contact phone 209-333-6800 Contact email Mail invoices to Account Information after CIW processing CERS (current submittal) field City of Lodi 111 PO Box 3006 113 Lodi, CA 95240 114, 115, 116 209 333 6800 112 Lodi City Well #15 3 830 N Lower Sacramento Rd 103 Lodi 104 95242 105 209 333 6800 102 1331 S Ham Ln 108a Lodi, CA 95240 108b, 1oac, 1o8d City of Lodi 140 1331 S Ham Ln 143 Lodi, CA 95240 144, 145, 146 209 333 6800 141 142 Program record HMBP [ ] SQG HW [ ] LQG HW [ ] RCRA HW New PR#: created [ ] Tiered permit [ ] APSA [ ] CalARP [ ] UST New PE: Assigned to: Please bill: [vj full calendar year [ ] prorate this calendar year [ ] next calendar year [ ] exempt from billing Processed through CERS Integration Wizard by:Date: 5'S't7 --------------- Accounting: Reviewed by:Date. �'1p / Clerical: [ ] File [ ] Relabel file [ ] Create new file _V�(cct billed_ [ _ urcharge verified _ _By:_ Date: ACTIVE PROGRAM RECORDS PRIOR TO PROCESSING THROUGH CIW Record ID Employee name Status Reactivated Inactivated 1921 - HMBP-Regular-Primary Location 1 chem units PR0541866 JAMIE LIMA Active I I I I `A/ti.ri�� • OQ ,,l C — jAW*a9.)-?3�