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SAN JOAQUIN COUNTY ENVIRONMENTAL HEALTH DEPARTMENT <br />Changes to EnvisionConnect by CERS Integration Wizard <br />Date run: 2/27/2018 <br />Submitted on: 1/23/2018 8:43:40AM CERS ID: 10661935 <br />Submitted by: Samantha Mcconville Email: samantha.mcconville@evoqua.com 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 />OW0021728 <br />Evoqua Water Technologies LLC <br />2650 Tallevast Road <br />Sarasota, FL 34243 <br />941-359-7930 <br />FACILITY FILE INFORMATION <br />Facility ID <br />FA0023481 <br />Facility name <br />Hospital LS <br />Site address <br />1772 E Scotts Ave <br />City <br />Stockton <br />ZIP code <br />95205 <br />Facility phone <br />941-962-9359 <br />Facility mailing address <br />2650 Tallevast Road <br />Sarasota, FL 34243 <br />BILLING INFORMATION <br />Contact name <br />Michael Smee <br />Address <br />2650 Tallevast Road <br />Sarasota, FL 34243 <br />Contact phone <br />941-359-7926 <br />Contact email <br />Michael.smee@evoqua.com <br />Mail invoices to <br />Account <br />Information after CIW processing CERS <br />(current submittal) field <br />Jennifer Miller111 <br />2650 Tallevast Road CC'' 113 <br />Sarasota, FL 34243 114, 115, 116 <br />(941) 359-7930 112 <br />Hospital LS <br />3 <br />333 W Mathews Rd <br />103 <br />French Camp <br />104 <br />95231 <br />105 <br />(941) 962-9359 <br />102 <br />2650 Tallevast Road <br />108a <br />Sarasota, FL 34243 <br />108b, 108c, 108d <br />Samantha McConville 140 <br />2650 Tallevast Road 143 <br />Sarasota, FL 34243 144, 145, 146 <br />(941) 359-7945 141 <br />samantha.mcconville@evoqua.com 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: ol-, Date: <br />Accounting: Reviewed by: 45 Date: ' -11� 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 />1921 - HMBP-Regular-Primary Location 1 chem units PR0541019 ROBERT LOPEZ Active [] [] <br />�_kM�2, OL Aaafg(7� *J i'9frec'-k t,�}jn� LACAI'fi) CIM '6 , a"Nb) , 01 nwAe/ <br />1\av"e- ('�Mrwa v�, Per R L gpe-L, <br />