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S:N:::UIN COUNTY ENVIRONMENTAL HEALTH DEPARTMENT <br /> anges to EnuisionConnect by CERS Integration Wizard <br /> Date run: 6/12/2014 <br /> Submitted on: 6/11/2014 12:22:27PM CERS ID: 10142589 <br /> Submitted by: Debra Voth Email: Debra.Voth@verizonwireless.com <br /> Facility ID in CERS: FA0010913 <br /> Information prier to CIW processing Information after CIW processing CERS <br /> OWNER INFORMATION (current EC database) (current submittal) field <br /> Owner ID OW0008734 <br /> Owner name Verizon Wireless Verizon Wireless 111 <br /> Mailing address 255 Parkshore Drive 255 Parkshore Drive 113 <br /> City Folsom Folsom 114 <br /> State CA CA 115 <br /> ZIP code 95630 95630 116 <br /> Work phone 866-694-2415 8666942415 112 <br /> FACILITY FILE INFORMATION <br /> Facility ID FA0010913 <br /> Facility name VERIZON WIRELESS -STKN BROOKSIDE Verizon Wireless Brookside 3 <br /> Site address 3122 BROOKSIDE RD 3122 Brookside Rd 103 <br /> City STOCKTON Stockton 104 <br /> Zip code 95207 95219 105 <br /> Facility phone 925-527-9600 8666942415 102 <br /> Facility mailing address 2785 MITCHELL DR 255 Parkshore Drive 108a <br /> BLDG 9 - 1 ST FLOOR <br /> City WALNUT CREEK Folsom 108b <br /> State CA CA 108c <br /> Zip code 94598 95630 108d <br /> BILLING INFORMATION <br /> Contact name VERIZON WIRELESS -STKN BROOKSIDE Environmental Compliance 140 <br /> Address 2785 MITCHELL DR 255 Parkshore Drive 143 <br /> City WALNUT CREEK Folsom 144 <br /> State CA CA 145 <br /> Zip code 94598 95630 146 <br /> Contact phone 925-279-6364 8666942415 141 <br /> Contact email Armand.De6gado a@VerizonWireless.Corn 142 <br /> Program record [ ] HMBP [ ] 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 VViv Date: g"1�j.kq <br /> Accounting: Reviewed by: ` Date: Clerical: /File [ ] Create new file <br /> [ ] Acc�d [ ] Surchar ifie—d By: Date: <br /> --- ———— -------- — ---- <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 PR0513201 LOWELLALLEN Active ( I [ j <br /> 2399-UNIFIED PROGRAM FAC STATE SURCHARGE FEE PRO510913 HAZ MAT SJC OES Inactive [ I [ ] <br />