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SAN JOAQUIN COUNTY ENVIRONMENTAL HEALTH DEPARTMENT <br />Changes to EnvisionConnect by CERS Integration Wizard Date run: 5/5/2017 <br />Submitted on: 3/2/2017 9:54:09AM <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: 24 <br />OW0000129 <br />City of Lodi <br />PO Box 3006 <br />Lodi, CA 95240 <br />209-333-6800 <br />FACILITY FILE INFORMATION <br />Facility ID <br />FA0005454 <br />Facility name <br />LODI CITY WELL #17 <br />Site address <br />2017 W VINE St <br />City <br />LODI <br />ZIP code <br />95240 <br />Facility phone <br />209-333-6706 <br />Facility mailing address <br />1331 SHAM LN <br />LODI, CA 95240 <br />BILLING INFORMATION <br />Contact name <br />CITY OF LODI <br />Address <br />125 N STOCKTON ST <br />LODI, CA 95240 <br />Contact phone <br />209-333-6706 <br />Contact email <br />Mail invoices to <br />Owner <br />CERS ID: 10729027 <br />Facility ID in CERS: incorrect <br />Information after CIW processing CERS <br />(current submittal) field <br />City of Lodi <br />111 <br />PO Box 3006 <br />113 <br />Lodi, CA 95240 <br />114, 115, 116 <br />209 333 6800 <br />112 <br />Lodi City Well #17 <br />3 <br />2017 W Vine St <br />103 <br />Lodi <br />104 <br />95242 <br />105 <br />209 333 6800 <br />102 <br />1331 S Ham Ln 108a <br />Lodi, CA 95240 108b, 108c, 108d <br />City of Lodi <br />140 <br />1331 S Ham Ln <br />143 <br />Lodi, CA 95240 <br />144, 145, 146 <br />209 333 6800 <br />141 <br />142 <br />Program record [VKHMBP [ ] SQG HW [ ] LQG HW [ ] RCRA HW New PR#: PRO S-Lki g6, <br />created [ ] Tiered permit [ ] APSA [ ] CalARP [ ] UST New PE: lilt <br />Assigned to: L� . �rg ",- <br />Please bill: N(full calendar year [ ] prorate this calendar year [ ] next calendar year [ ] exempt from billing <br />Processed through CERS Integration Wizard by: Date: <br />----------------------------------- <br />Accounting: Reviewed by: 46 Date: ��/D �/ Clerical: [ ] File [ ] Relabel file [ ] Create new file <br />[ yAcct billed _ [ ]surcharge verified By: _ Date: <br />ACTIVE PRO/GRAM RECORDS PRIOR TO PROCESSING THROUGH CIW <br />Record ID Employee name Status Reactivated Inactivated <br />2381 - UST FACILITY (BEFORE 1/84) - obsolete PR0502459 ONE VACANTI Inactive I I I <br />3((� Ltf l a -,c^. oc*v..l C-2_ <br />t�W-4 4e Of <br />