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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 10:00:02AM CERS ID: 10725931 <br />Submitted by: Bill Cooper Email: bcooper@lodi.gov Facility ID in CERS: incorrect <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 />OW0022472 <br />City og Lodi <br />PO BOX 3006 <br />Lodi, CA 95240 <br />209-333-6800 <br />FACILITY FILE INFORMATION <br />Facility ID <br />FA0024005 <br />Facility name <br />Lodi City Well #1 R <br />Site address <br />705 E Lodi Ave <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 />Information after CIW processing <br />Lodi, CA 95240 <br />BILLING INFORMATION <br />field <br />Contact name <br />City og Lodi well 1 R <br />Address <br />1331 S. Ham Ln <br />PO BOX 3006 <br />Lodi, CA 95240 <br />Contact phone <br />209-333-6800 <br />Contact email <br />112 <br />Mail invoices to <br />Account <br />Information after CIW processing <br />CERS <br />(current submittal) <br />field <br />of <br />104 <br />City Lodi <br />111 <br />PO BOX 3006 <br />113 <br />Lodi, CA 95240 <br />114, 115, 116 <br />2093336800 <br />112 <br />Lodi City Well #1 R <br />3 <br />705 E Lodi Ave <br />103 <br />Lodi <br />104 <br />95240 <br />105 <br />2093336800 <br />102 <br />1331 S. Ham Ln. 108a <br />Lodi, CA 95240 108b, 1o8c, 1o8d <br />og <br />City Lodi well 1 R <br />140 <br />1331 S. Ham Ln <br />143 <br />Lodi, CA 95240 <br />144, 145, 146 <br />2093336800 <br />141 <br />142 <br />Program record NT 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: [%,K�fu II calendar year [ ] prorate this calendar year [ ] next calendar year [ ] exempt from billing <br />Processed through CERS Integration Wizard by: OCVI-^ tO- Date: 5—S-47 <br />Accounting: Reviewed by: tb Date: /0 I Clerical: [ ] File [ ] Relabel file [ ] Create new file <br />�A'Acct billed Surcharge 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 PR0541856 JAMIE LIMA Active I I I <br />Aa,,, c9t. ,nitt �mJ VA) \ 04 twonrUlv,,, ��v� U -M 54✓r+V4 , a [�q_ <br />t'�W -0 ;?- q -,�,? 3 q <br />