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SAN JOAQUIN COUNTY ENVIRONMENTAL HEALTH DEPARTMENT <br />Changes to EnvisionConnect by CERS Integration Wizard <br />Date run: 1/25/2016 <br />Submitted on: 1/11/2016 10:07:45AM <br />Submitted by: George Montross Email: gmontross@ci.manteca.ca.us <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 : 39 <br />OW0000353 <br />MANTECA, CITY OF <br />1001 W CENTER ST <br />MANTECA, CA 95337 <br />209-456-8460 <br />FACILITY FILE INFORMATION <br />Facility ID <br />FA0010610 <br />Facility name <br />MANTECA WELL #10 <br />Site address <br />724 E ALAMEDA ST <br />City <br />MANTECA <br />ZIP code <br />95336 <br />Facility phone <br />209-456-8621 <br />Facility mailing address <br />1001 W CENTER ST <br />MANTECA, CA 95337 <br />BILLING INFORMATION <br />Contact name <br />MANTECA WELL #10 <br />Address <br />1001 W CENTER ST <br />MANTECA, CA 95337 <br />Contact phone <br />Not Specified <br />Contact email <br />Mail invoices to <br />Account <br />CERS ID: 10183669 <br />Facility ID in CERS: FA0010610 <br />Information after CIW processing CERS <br />(current submittal) field <br />MANTECA, CITY OF 111 <br />1001 W CENTER ST 113 <br />MANTECA, CA 95337 114, 115, 116 <br />209-456-8460 112 <br />MANTECA WELL #10 3 <br />724 E ALAMEDA ST 103 <br />MANTECA 104 <br />95336 105 <br />(209) 456-8621 102 <br />1001 W CENTER ST 108a <br />MANTECA, CA 95337 108b, 108c, 108d <br />MANTECA WELL #10 140 <br />1001 W CENTER ST 143 <br />MANTECA, CA 95337 144, 145, 146 <br />209-456-8460 141 <br />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 thiscalendaryear [ ] next calendar year [ ] exempt from billing <br />Processed through CERS Integration Wizard by: Date: <br />Accounting: Reviewed by: U6 Date: , (;-.L Clerical: [ ] File [ ] Relabel file [ ] Create 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 />1926 - HMBP-Unstaffed Network Location PR0512898 NICHOLAS LOEHRER Active <br />2399 - UNIFIED PROGRAM FAC STATE SURCHARGE FEE PR0510610 HAZ MAT SJC OES Inactive [ ] [ ] <br />