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SAN JOAQUIN COUNTY ENVIRONMENTAL HEALTH DEPARTMENT <br />Changes to EnvisionConnect by CERS Integration Wizard <br />Date run: 5/5/2017 <br />Submitted on: 3/2/2017 10:12:31AM <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 />OW0022474 <br />City of Lodi <br />PO Box 3006 <br />Lodi, CA 95240 <br />209-333-6800 <br />FACILITY FILE INFORMATION <br />Facility ID <br />FA0024007 <br />Facility name <br />Lodi City Well #6R <br />Site address <br />224 Mission St <br />City <br />Lodi <br />ZIP code <br />95240 <br />Facility phone <br />209-333-6800 <br />Facility mailing address <br />1331 S Ham Ln <br />Lodi, CA 95240 <br />BILLING INFORMATION <br />Contact name <br />City of Lodi <br />Address <br />1331 S Ham Ln <br />Lodi, CA 95240 <br />Contact phone <br />209-333-6800 <br />Contact email <br />Mail invoices to <br />Account <br />CERS ID: 10725940 <br />Facility ID in CERS: incorrect <br />Information after CIW processing CERS <br />(current submittal) field <br />City of Lodi 111 <br />PO Box 3006 113 <br />Lodi, CA 95240 114, 115, 116 <br />209 333 6800 112 <br />Lodi City Well #6R <br />3 <br />224 Mission St <br />103 <br />Lodi <br />104 <br />95240 <br />105 <br />209 333 6800 <br />102 <br />1331 S Ham Ln 108a <br />Lodi, CA 95240 108b, 108c, 1084 <br />City of Lodi <br />140 <br />1331 S Ham Ln <br />143 <br />Lodi, CA 95240 <br />144, 145, 146 <br />209 333 6800 <br />141 <br />142 <br />Program record [vj 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: [v1 full calendar year [ ] prorate this calendar year [ ] next calendar year [ ] exempt from billing <br />Processed through CERS Integration Wizard by: �ov� 1�;— Date: 5-5-17 <br />----------------------------- <br />Accounting: Reviewed by: _146 Date: 51 to 1 Clerical: [ ] File [ ] Relabel file [ ] Create new file <br />[ �Xcct billed [ jAurcharge 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 PRO541858 JAMIE LIMA Active I I I I <br />Xjz�'l v��er,I��� �� (�r� yr�.r �� per �-Ck'> 5►,0��,� .rte <br />�1�Z9�-7310 <br />