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E- SAN JOAQUIN COUNTY ENVIRONMENTAL HEALTH DEPARTMENT <br /> Changes to EnvisionConnect by CERS Integration Wizard <br /> Date run: 6/13/2014 <br /> Submitted on: 6/11/2014 1:21:22PM CERS ID: 10143139 <br /> Submitted by: Debra Voth Email: Debra.Voth@verizonwireless.com Facility ID in CERS: FA0022084 <br /> Information prior 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 FA0022084 <br /> Facility name VERIZON WIRELESS ELLIOTT RD Verizon Wireless Elliott Road 3 <br /> Site address 27047 N ELLIOTT RD 27047 Elliott Road 103 <br /> City GALT Galt 104 <br /> Zip code 95632 95632 105 <br /> Facility phone 866-694-2415 8666942415 102 <br /> Facility mailing address 255 PARKSHORE RD 255 Parkshore Drive 108a <br /> City FOLSOM Folsom 108b <br /> State CA CA 108c <br /> Zip code 95630 95630 108d <br /> BILLING INFORMATION <br /> Contact name VERIZON WIRELESS ELLIOTT RD Environmental Compliance 140 <br /> Address 255 PARKSHORE RD 255 Parkshore Drive 143 <br /> City FOLSOM Folsom 144 <br /> State CA CA 145 <br /> Zip code 95630 95630 146 <br /> Contact phone Not Specified 8666942415 141 <br /> Contact email Armand.Delgado@VerizonWireless.Com 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: ` Date: (o•15-1* <br /> ---- <br /> Accounting: Reviewed b : �Y Date:�� Clerical: File <br /> y TT" [ ] Create new file <br /> [ ] Ac ed [ ] Surch verified 1 t 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 PRO538212 HAZA SAEED Active 11 11 <br />