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SAN JOAQUIll COUNTY ENVIRONMENTAL HEALTh%WEPARTMENT <br />Changes to EnvisionConnect by CERS Integration Wizard <br />Date run: 1/5/2015 <br />Submitted on: 12/22/2014 5:13:10PM CERS ID: 10412392 <br />Submitted by: Pierre Belanger Email: pierre.belanger@cepheid.com Facility ID in CERS: FA0021944 <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 />OW0018063 <br />Cepheid <br />401 South Main Street <br />Lodi, CA 95240 <br />209-334-5283 <br />FACILITY FILE INFORMATION <br />Facility ID <br />FA0021944 <br />Facility name <br />CEPHEID MAIN <br />Site address <br />401 S MAIN ST <br />City <br />LODI <br />ZIP code <br />95240 <br />Facility phone <br />209-334-5283 <br />Facility mailing address <br />401 S MAIN ST <br />401 S. Main Street <br />LODI, CA 95240 <br />BILLING INFORMATION <br />114, 115, 116 <br />Contact name <br />CEPHEID MAIN <br />Address <br />401 S MAIN ST <br />LODI, CA 95240 <br />Contact phone <br />Not Specified <br />Contact email <br />Mail invoices to <br />Facility <br />Information after CIW processing CERS <br />(current submittal) field <br />Cepheid Lodi, LLC <br />111 <br />401 S. Main Street <br />113 <br />Lodi, CA 95240 <br />114, 115, 116 <br />209 334-5283 <br />112 <br />Cepheid Lodi, LLC <br />3 <br />401 S Main St <br />103 <br />Lodi <br />104 <br />95240 <br />105 <br />209 334-5283 <br />102 <br />401 S. Main Street 108a <br />Lodi, CA 95240 108b, 108c, 108d <br />Derek Beattie <br />140 <br />401 S. Main Street <br />143 <br />Lodi, CA 95240 <br />144, 145, 146 <br />209 334-5283 <br />141 <br />derek.beattie@cepheid.com <br />142 <br />Program record [ ] HMBP [ ] SQG HW [ ] LQG HW [ ] RCRAHW New PR#:NQS-Iyi 25 <br />created [ ] Tiered permit [ ] APSA [ ] CaIARP [ ] UST New PE: Z-1-0 <br />Assigned to: VC-4�0S17 <br />Please bill: 9 full calendar year [ ] prorate this <br />_ 1calendar year [ ] next calendar year [ ] exempt from billing <br />Processed through CERS Integration Wizard by: ,� Date: 1. .5 q <br />Accounting: Reviewed by: � Date: 151/5 Clerical: [ ] File [ ] Relabel file 'KCreate new file <br />[ ] Acct billed [ ] Surcharge verified By: Date: <br />ACTIVE PROGRAM RECORDS PRIOR TO PROCESSING THROUGH CIW <br />Program Element and Description Record ID Employee name Status Reactivated Inactivated <br />1921 - HMBP-Regular-Primary Location PRO538008 JAMIE DE LA ROSA Active I I I I <br />