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Adbk left, <br /> SAN JOAQUI OUNTY ENVIRONMENTAL HEALTH PARTMENT <br /> Changes to EnvisionConnect by CERS Integration Wizard <br /> Date run: 6/30/2014 <br /> Submitted on: 4/17/2014 10:29:45AM CERS ID: 10183831 <br /> Submitted by: Cathy Otte Email: cotte@chw.edu Facility ID in CERS: FA0010809 <br /> Information prior to CIW processing Information after CIW processing CERS <br /> OWNER INFORMATION (current EC database) (current submittal) field <br /> Owner ID OW0008809 <br /> Owner name OCONNOR WOODS HOUSING CORP OCONNOR WOODS HOUSING CORP 111 <br /> Mailing address 3400 DATA DR 3400 WAGNER HEIGHTS RD 113 <br /> RANCHO CORDOVA, CA 95670 STOCKTON, CA 95209 114, 115, 116 <br /> Work phone 209-956-3400 209-956-3400 112 <br /> FACILITY FILE INFORMATION <br /> Facility I D FA0010809 <br /> Facility name MEADOWOOD A HEALTH & REHAB CTR MEADOWOOD A HEALTH & REHAB CTR 3 <br /> Site address 3110 WAGNER HEIGHTS RD 3110 WAGNER HEIGHTS RD 103 <br /> City STOCKTON STOCKTON 104 <br /> Zip code 95209 95209 105 <br /> Facility phone 209-956-3444 (209) 956-3444 102 <br /> Facility mailing address 3110 WAGNER HEIGHTS RD 3110 WAGNER HEIGHTS RD 108a <br /> STOCKTON, CA 95209 STOCKTON, CA 95209 108b,108c,108d <br /> BILLING INFORMATION <br /> Contact name MEADOWOOD A HEALTH & REHAB CTR MEADOWOOD A HEALTH & REHAB CTR 140 <br /> Address 3110 WAGNER HEIGHTS RD 3110 WAGNER HEIGHTS RD 143 <br /> STOCKTON, CA 95209 STOCKTON, CA 95209 144, 145, 146 <br /> Contact phone 209-956-3459 209-956-3444 141 <br /> Contact email 142 <br /> Mail invoices to Facility <br /> Program record [ ] HMBBP [ ] SQG HW [ ] LQG HW [ ] RCRA HW New PR#: <br /> created [ ] Tiered permit [ ] APSA [ ] CalARP [ ] UST 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: Date: <br /> Accounting: Reviewed by: Date: >ldjo Clerical: [ ] File [ ] Relabel file [ ] Create new file <br /> [ ] Ac illed [ ] Surch enfled ; ! By: Date: <br /> ACTIVE PROGRAM RECORDS PRIOR TO PROCESSING THROUGH CIW <br /> Program Element and Description Record ID Employee name Status Reactivated Inactivated <br /> 1628-LICENSED HEALTH CARE FACILITY PRO527305 NICHOLAS WIESEMAN Active { ] [ ] <br /> 1921 -HMBP-Regular-Primary Location PR0521180 HAZA SAEED Active [ ] [ ] <br /> 2399-UNIFIED PROGRAM FAC STATE SURCHARGE FEE PR0510809 HAZ MAT SJC OES Inactive [ ] [ ] <br /> ERSC-ELECTRONIC REPORTING STATE SURCHARGE F PR0534014 not assigned Inactive [ ] [ ] <br />