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[--:: QUINACOUNTY ENVIRONMENTAL HEALTH DEPARTMENT <br /> Changes to EnvisionConnect by CERS Integration Wizard <br /> Date run: 6/12/2014 <br /> Submitted on: 1/28/2014 11:33:51AM CERS ID: 10141123 <br /> Submitted by: Steve Skanderson Email: Steve skanderson@stantec.com� Facility ID in CERS: FA0010736 <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 CALIFORNIA INC 111 <br /> Mailing address 255 Parkshore Drive 280 Sr Locust Street 113 <br /> City Folsom Pomona 114 <br /> State CA CA 115 <br /> ZIP code 95630 91766 116 <br /> Work phone 866-694-2415 972-729-5143 112 <br /> FACILITY FILE INFORMATION <br /> Facility ID FA0010736 <br /> Facility name VERIZON WIRELESS INC Verizon California Clements CO 3 <br /> Site address HWY 881 MACKVILLE NW CIO Hwy 88 & Mackvilie Road 103 <br /> City CLEMENTS Clements 104 <br /> Zip code 95227 95227 105 <br /> Facility phone 209-239-0258 209-759-0070 102 <br /> Facility mailing address 2785 MITCHELL DR 280 S. Locust Street 108a <br /> BLDG 9 - 1 ST FLOOR <br /> City WALNUT CREEK Pomona 108b <br /> State CA CA 108r- <br /> Zip code 94598 91766 1084 <br /> BILLING INFORMATION <br /> Contact name VERIZON WIRELESS INC Zachary Feingold 140 <br /> Address 2785 MITCHELL DR 280 S. Locust Street 143 <br /> City WALNUT CREEK Pomona 144 <br /> State CA CA 145 <br /> Zip code 94598 91766 146 <br /> Contact phone 925-279-6364 972-729-5143 141 <br /> Contact email zachary.d.feingold agverizon.com 142 <br /> Program record [ ] HMBP [ ] SCG HW [ ] LOG 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: vl� Date: <br /> Accounting: Reviewed by: �— Date: f�7 ` Clerical: �/]�File [ ] Create new file <br /> [ ] AcctbtTe-d [ ] Surcherifie 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 PRO513024 MICHAEL PARISSI Active [ ] [ ] <br /> 2226-CaIARP PROGRAM PR0514850 HAZ MAT SJC OES Inactive [ ] [ ] <br /> 2399-UNIFIED PROGRAM FAC STATE SURCHARGE FEE PRO510736 HAZ MAT SJC OES Inactive [ ] [ ] <br />