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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 8:04:34AM <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 />OW0022471 <br />City of Lodi <br />PO BOX 3006 <br />Lodi, CA 95241 <br />209-333-6800 <br />FACILITY FILE INFORMATION <br />Facility ID <br />FA0024004 <br />Facility name <br />Lodi City Well #24 <br />Site address <br />640 N Stockton St <br />City <br />Lodi <br />ZIP code <br />95240 <br />Facility phone <br />209-333-6800 <br />Facility mailing address 1331 S. Ham Ln <br />Lodi, CA 95240 <br />BILLING INFORMATION <br />Contact name City of Lodi Well #24 <br />Address 1331 S. Ham Ln <br />Lodi, CA 95240 <br />Contact phone 209-333-6800 <br />Contact email <br />Mail invoices to Account <br />Program record [�/j HMBP [ ] SQG HW <br />created [ ] Tiered permit [ ] APSA <br />CERS ID: 10725928 <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 95241 114, 115, 116 <br />2093336800 112 <br />Lodi City Well #24 3 <br />640 N Stockton St 103 <br />Lodi 104 <br />95240 105 <br />2093336800 102 <br />1331 S. Ham Ln 108a <br />Lodi, CA 95240 108b, 108c, 108d <br />City of Lodi Well #24 140 <br />1331 S. Ham Ln 143 <br />Lodi, CA 95240 144, 145, 146 <br />2093336800 141 <br />142 <br />[ ] LQG HW [ ] RCRA HW <br />[ ] CaIARP [ ] UST <br />Please bill: [VI full calendar year [ ] prorate this calendar year <br />New PR#: _ <br />New PE: <br />Assigned to: <br />[ ] next calendar year [ ] exempt from billing <br />Processed through CERS Integration Wizard by: Date: <br />Accounting: Reviewed by: Date: 5J�DT7 Clerical: [ ] File [ ] Relabel file [ ] Create new file <br />[ ]�,�cct billed [ urcharge -- <br />—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 PR0541855 JAMIE LIMA Active I I I i <br />Iv6-1 (-9(,,AQ(, �r�C.l���'� 1 �ln� PO /aw) i-�`�✓.n "t'r`7 �iubw �'[w1. IJAiv�% <br />(�nN�a9�7a3 <br />