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SAN JOAQUIN COUNTY ENVIRONMENTAL HEALTH DEPARTMENT <br /> Changes to EnvisionConnect by CERS Integration Wizard Date run: 6/13/2014 <br /> Submitted on: 6/12/2014 12:56:17PM 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 /> 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 FA0010751 <br /> Facility name VERIZON WIRELESS -STKN AUTO CTR Verizon Wireless Stockton Auto Mall (Auto C 3 <br /> Site address 5880 HOLMAN RD 5880 HolQlan Rd 103 <br /> City STOCKTON StocKton 104 <br /> Zip code 95212 95212 105 <br /> Facility phone 925-527-9600 8666942415 102 <br /> Facility mailing address 2785 MITCHELL DR 255��e 108a <br /> BLDG 9- 1ST FLOOR <br /> City WALNUT CREEK Ealsom 108b <br /> State CA Q6—, 108c <br /> Zip code 94598 95630 108d <br /> BILLING INFORMATION <br /> Contact name VERIZON WIRELESS-STKN AUTO CTR Environmental Compliance 140 <br /> Address 2785 MITCHELL DR 255 Parkshore Drive 143 <br /> City WALNUT CREEKo s0F'T m 144 <br /> State CA C, — 145 <br /> Zip code 94598 -9530 146 <br /> Contact phone 925-279-6364 8666942415 141 <br /> Contact email n^ n Armand.Delgado@VerizonWireless.Com 142 <br /> Program record [ ] HMBP [ ] SQG 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 <br /> ,� \ \ <br /> calendar year [ ] next calendar year [ ] exempt from billing <br /> Processed through CERS Integration Wizard by: " '_1[ Date: (O-f3-I ' <br /> ---------------------------------------------------- <br /> Accounting: Reviewed by: t6 Date: ql5VW Clerical: Vf File [ ] Create new file <br /> ----_ — [ ] Acct bled--[ ] Surchar I led By: Date: <br /> -- ------------------------------- <br /> CTIVE 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 PRO513039 HAZA SAEED Active [ ] [ ] <br /> 2399-UNIFIED PROGRAM FAC STATE SURCHARGE FEE PRO510751 HAZ MAT SJC DES Inactive [ ] [ ] <br />