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SAN JOAQUIN COUNTY ENVIRONMENTAL HEALTH DEPARTMENT <br />Changes to EnvisionConnect by CERS Integration Wizard <br />Date run: 1/10/2017 <br />Submitted on: 1/3/2017 10:23:17PM CERS ID: 10636987 <br />Submitted by: Debra Voth Email: Debra.Voth@verizonwireless.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 />OW0021144 <br />Verizon Wireless <br />295 Parkshore Drive <br />Folsom, CA 95630 <br />866-694-2415 <br />FACILITY FILE INFORMATION <br />Facility ID <br />FA0023074 <br />Facility name <br />Verizon Wireless Manteca Marketplace <br />Site address <br />1323 W CENTER ST <br />City <br />Manteca <br />ZIP code <br />95337 <br />Facility phone <br />866-694-2415 <br />Facility mailing address <br />295 Parkshore Drive <br />Folsom, CA 95630 <br />BILLING INFORMATION <br />Contact name <br />Verizon Wireless <br />Address <br />295 Parkshore Drive <br />Folsom, CA 95630 <br />Contact phone <br />866-694-2415 <br />Contact email <br />armand.delgado@vzw.com <br />Mail invoices to <br />Account <br />Information after CIW processing CERS <br />(current submittal) field <br />Verizon Wireless 111 <br />295 Parkshore Drive 113 <br />Folsom, CA 95630 114, 115, 116 <br />(866) 694-2415 112 <br />Verizon Wireless Manteca Marketplace <br />3 <br />1323 W Center St <br />103 <br />Manteca <br />104 <br />95337 <br />105 <br />(866) 694-2415 <br />102 <br />295 Parkshore Drive 108a <br />Folsom, CA 95630 10W 108c, 108d <br />Verizon Wireless 140 <br />295 Parkshore Drive 143 <br />Folsom, CA 95630 144, 145, 146 <br />(866)694-2415 141 <br />armand.delgado@vzw.com 142 <br />Program record [ ] HMBP [ ] SOG HW [ ] LOG 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: I Date: <br />Accounting: Reviewed by: Date: / ( D 117 Clerical: [ ] File [ ] Relabel file [ ] Create new file <br />[ ] Acct billed [ ] Surcharge verified By: Date: <br />ACTIVE PROGRAM RECORDS PRIOR TO PROCESSING THROUGH CIW <br />l� Record ID Employee name Status Reactivated Inactivated <br />1926 - HMBP-Remote Network Location 2 chem units PR0540372 PETER LOMBARDI Active [ ] [ ] <br />