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SAN JOAQUIN COUNTY ENVIRONMENTAL HEALTH DEPARTMENT Changes to EnvisionConnect by CERS Integration Wizard Date run: 7/30/2018 Submitted on: 1/23/2018 12:06:56PM CERS ID: 10181827 Submitted by: Andrew Richle Email: arichle@lodi.gov Facility ID in CERS: FA0005457 OWNER INFORMATION Owner ID Owner name Mailing address Work phone Information prior to CIW processing (current EC database Number of Facilities for this Ow r : 24 OW0000129 CITY OF LODI PO BOX 3006 LODI, CA 95241 209-333-6800 FACILITY FILE INFORMATION Facility ID FA0005457 Facility name LODI CITY WELL #5 Site address 401 N MILLS AVE City LODI ZIP code 95242 Facility phone 209-333-6800 Facility mailing address 1331 S HAM LN LODI, CA 95242 BILLING INFORMATION Contact name CITY OF LODI Address PO BOX 3006 LODI, CA 95241-1910 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 95241 114, 115, 116 2093336800 112 LODI CITY WELL #5 3 401 N MILLS Ave 103 LODI 104 95242 105 2093336800 102 1331 S HAM LN 108a LODI, CA 95242 108b, 108c, 108d CITY OF LODI 140 125 N STOCKTON ST 143 LODI, CA 95240 144, 145, 146 2093336800 141 142 Program record [ ] HMBP [ ] SQG HW [ ] LQG HW [ ] RCRA HW created [ ] Tiered permit [ ] APSA [ ] CalARP [ ] UST New PR#: _ New PE: Assigned to: Please bill: [ ] full calendar year [ ] prorate this calendar year [ ] next calendar year [ ] exempt from billing Processed through CERS Integration Wizard by: Date: Accounting: Reviewed by: Date: g 17 Clerical: [ ] File [ ] Relabel file [ ] Create new file [ ] Acct billed [ ] Surcharge verified By: Date: ACTIVE PROGRAM RECORDS PRIOR TO PROCESSING THROUGH CIW Record ID Employee name Status Reactivated Inactivated 1921 - HMBP-Regular-Primary Location 2 chem units PR0513004 JAMIE LIMA Active [ ] [ ] 2381 - UST FACILITY (BEFORE 1/84) - obsolete PR0502465 ONE VACANT1 Inactive [ ] [ ] 2399 - UNIFIED PROGRAM FAC STATE SURCHARGE FEE PR0510716 HAZ MAT SJC OES Inactive [ ] [ ] 2840 - AST EXEMPT FAC < 1,320 GAL PR0528450 AARON HANG Inactive [ ] [ ]