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SAN JOAQUIN COUNTY ENVIRONMENTAL HEALTH DEPARTMENT <br />Changes to EnvisionConnect by CERS Integration Wizard <br />Date run: 1/13/2017 <br />Submitted on: 1/9/2017 10:10:28AM <br />Submitted by: Matt Meyer Email: mmeyer@sjgov.org <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 : 20 <br />OW0008853 <br />San Joaquin County <br />1702 E. Scotts St <br />Stockton, CA <br />209-468-3090 <br />FACILITY FILE INFORMATION <br />Facility ID <br />FA0023395 <br />Facility name <br />Flag City Well #3 <br />Site address <br />15184 N Thornton Rd <br />City <br />Lodi <br />ZIP code <br />95242 <br />Facility phone <br />209-468-3090 <br />Facility mailing address <br />1702 E. Scotts <br />Stockton, CA <br />BILLING INFORMATION <br />Contact name <br />San Joaquin County- Utilities <br />Address <br />1702 E. Scotts <br />Stockton, CA <br />Contact phone <br />209-468-3090 <br />Contact email <br />Mail invoices to <br />Account <br />CERS ID: 10669231 <br />Facility ID in CERS: FA0023395 <br />Information after CIW processing CERS <br />(current submittal) field <br />San Joaquin County 111 <br />1702 E. Scotts 113 <br />Stockton, CA 114, 115, 116 <br />2094683090 112 <br />Flag City Well #3 3 <br />15184 N Thornton Rd 103 <br />Lodi 104 <br />95242 105 <br />2094683090 102 <br />1702 E. Scotts 108a <br />Stockton, CA 108b, 108c, 10ad <br />San Joaquin County 140 <br />1702 E. Scotts 143 <br />Stockton, CA 144, 145, 146 <br />2094683090 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: G 1/[ Date: U 13/1-7 <br />Accounting: Reviewed by: Date: f / i 7 Clerical: [ ] File [ ] Relabel file [ ] Create new file <br />[ ] Acct billed [ ] Surcharge verified By: Date: <br />ACTIVE PROGRAM RECORDS PRIOR TO PROCESSING THROUGH CIW <br />Record ID Employee name Status Reactivated Inactivated <br />1920 - HMBP-Common Materials 0 chem units PR0540896 JAMIE LIMA Active I I I I <br />