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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 1:11:31 PM CERS ID: 10142957 <br /> Submitted by: Debra Voth Email: Debra.Voth@verizonwireless.com Facility ID in CERS: FAD010697 <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 FA0010697 <br /> Facility name VERIZON WIRELES -DELICATO CELL SIT Verizon Wireless Delicato 3 <br /> Site address 3668 E FRENCH CAMP RD 3668 French Camp Rd 103 <br /> City MANTECA Manteca 104 <br /> Zip code 95336 95336 105 <br /> Facility phone 209-982-0135 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 1080 <br /> Zip code 94598 95630 108d <br /> BILLING INFORMATION <br /> Contact name VERIZON WIRELES -DELICATO CELL SITI 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.Delgado@VerizonWireless.Com 142 <br /> Program record [ ] HMBP [ ] SOG 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: llXA� Date: �y'13, I1�- <br /> [ ] <br /> Accounting: Reviewedby: Date: Pe Clerical: the ] Createnewfile <br /> Acd SurcifiBy: Date:geGer <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 PR0512985 HAZA SAEED Active [ ] ( } <br /> 2399-UNIFIED PROGRAM FAC STATE SURCHARGE FEE PR0510697 HAZ MAT SJC OES Inactive [ ] [ ] <br />