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SAN JOAQUiR'COUNTY ENVIRONMENTAL HEALTHVEPARTMENT <br /> Changes to EnvisionConnect by CERS Integration Wizard Date run: 6/12/2015 <br /> CERS ID: 10415419 <br /> Submitted on: 6/5/2015 3:17:16PM <br /> Facility ID in CERS: FA0022499 <br /> Submitted by: Julie Anenson Email: julie.anenson@cbi.com <br /> Information prior to CIW processing Information after CIW processing CERS <br /> (current EC database) (current submittal) field <br /> OWNER INFORMATION <br /> Owner ID OW0020004 <br /> Owner name New Cingular Wireless PCS, LLC dba AT&T New Cingular Wireless PCS, LLC dba AT&T 113 <br /> Mailing address PO BOX 5095, RM 4W200 308 S. Akard St., Room 1708 11a 115,116 <br /> SAN RAMON, CA 94583 Dallas, TX 75202 112 <br /> Work phone 925-823-8954 214-464-2626 <br /> FACILITY FILE INFORMATION <br /> Facility ID FA0022499 <br /> Facility name AT&T Mobility- LINDEN (9858) AT&T Mobility- LINDEN (9858) 3 <br /> Site address 5252 N ESCALON BELLOTA RD 5252 NORTH ESCALON BELLOTA ROAD 103 <br /> 04 <br /> City LINDEN LINDEN <br /> ZIP code 95236 95236 105 <br /> Facility phone 800-638-2822 8006382822 102 <br /> Facility mailing address PO BOX 5095, RM 4W200 308 S. Akard St., Room 1708 1os6,08oaoad <br /> SAN RAMON, CA 94583 Dallas,TX 75202 <br /> BILLING INFORMATION <br /> Contact name Manager EH&S EPCRA AT&T Mobility Manager EH&S EPCRA 140 <br /> Address PO BOX 5095, RM 4W200 5001 Executive Pkwy, RM 4W2001 143 <br /> SAN RAMON, CA 94583 San Ramon, CA 94583 144, 145, 146 <br /> Contact phone 925-823-8954 214-464-2626 141 <br /> Contact email g43573@att.com g43573@att.com 142 <br /> Mail invoices to Account <br /> Program record [ ] HMBP [ ] SCG HW [ ] LQG HW [ ] RCRA HW New PR#: <br /> created [ ] Tiered permit [ ] APSA [ ] CaIARP [ ] 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: 20 Date: <br /> -------------------------------------------------- <br /> Accounting: Reviewed by: _�J _Date: &P11 40 S 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 PRO539353 JAMIE DE LA ROSA Active, Exempt I I I I <br />