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SAN JOAQUt.rCOUNTY ENVIRONMENTAL HEALTh--dEPARTMENT <br /> Changes to EnvisionConnect by CERS Integration Wizard Date run: 3/17/2015 <br /> Submitted on: 1/23/2015 2:15:58PM CERS ID: 10145389 <br /> Submitted by: Debra Voth Email: Debra.Voth@verizonwireless.com Facility ID in CERS: FA0010751 <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 /> Folsom, CA 95630 Folsom, CA 95630 114, 115, 116 <br /> Work phone 866-694-2415 8666942415 112 <br /> FACILITY FILE INFORMATION <br /> Facility ID FA0010751 <br /> Facility name Verizon Wireless Stockton Auto Mall (Auto C Verizon Wireless Stockton Auto Mall (Auto C 3 <br /> Site address 5880 Holman Rd 5880 Holman Rd 103 <br /> City Stockton Stockton 104 <br /> ZIP code 95212 95212 105 <br /> Facility phone 866-694-2415 8666942415 102 <br /> Facility mailing address 255 Parkshore Dr 255 Parkshore Drive 108a <br /> Folsom, CA 95630 Folsom, CA 95630 108b, 108c 108d <br /> BILLING INFORMATION <br /> Contact name Verizon Wireless Environmental Compliance 140 <br /> Address 255 Parkshore Dr 255 Parkshore Drive 143 <br /> Folsom, CA 95630 Folsom, CA 95630 144, 145, 146 <br /> Contact phone Not Specified 8666942415 141 <br /> Contact email Armand.Delgado@VerizonWireless.Com Armand.Delgado@VerizonWireless.Com 142 <br /> Mail invoices to Account <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 /> / <br /> Processed through CERS Integration Wizard by: '� M Date: )`[7-15 <br /> Accounting: Reviewed by: [b Date: 3 8 I 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 PR0513039 HAZA SAEED Active I ] I ] <br /> 2399-UNIFIED PROGRAM FAC STATE SURCHARGE FEE PRO510751 HAZ MAT SJC OES Inactive I ] I ] <br />