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SAN JOAQUII .;OUNTY ENVIRONMENTAL HEALTh _-PARTMENT <br />Changes to EnvisionConnect by CERS Integration Wizard <br />Date run: 3/17/2015 <br />Submitted on: 1/23/2015 1:52:50PM <br />Submitted by: Debra Voth Email: Debra.Voth@verizonwireless.com <br />OWNER INFORMATION <br />Owner ID <br />Owner name <br />Mailing address <br />Work phone <br />Information prior to CIW processing <br />(current EC database) <br />OW0008734 <br />Verizon Wireless <br />255 Parkshore Drive <br />Folsom, CA 95630 <br />866-694-2415 <br />FACILITY FILE INFORMATION <br />Facility ID <br />FA0019359 <br />Facility name <br />VERIZON WIRELESS - JACKTONE <br />Site address <br />3264 N JACK TONE RD <br />City <br />LINDEN <br />ZIP code <br />95236 <br />Facility phone <br />925-527-9600 <br />CERS ID: 10143903 <br />Facility ID in CERS: FA0019359 <br />Information after CIW processing CERS <br />(current submittal) field <br />Verizon Wireless <br />111 <br />255 Parkshore Drive <br />113 <br />Folsom, CA 95630 <br />114, 115, 116 <br />8666942415 <br />112 <br />Verizon Wireless Jacktone 3 <br />J w 6 103 <br />Stockton �jt� ^J J-P_�'Tpytt/ 104 <br />95236 105 <br />8666942415 �� 102 <br />Facility mailing address 2785 MITCHELL DR BLDG 9 1ST FLOOR 255 Parkshore Drive <br />WALNUT CREEK, CA 94598 Folsom, CA 95630 <br />Amwill Its] 1116 :17 7 IT -1 epi/ <br />108a <br />108b, 108c, 108d <br />Contact name <br />VERIZON WIRELESS - JACKTONE <br />Environmental Compliance <br />140 <br />Address <br />2785 MITCHELL DR BLDG 9 1ST FLOOR <br />255 Parkshore Drive <br />143 <br />WALNUT CREEK, CA 94598 <br />Folsom, CA 95630 <br />144, 145, 146 <br />Contact phone <br />Not Specified <br />8666942415 <br />141 <br />Contact email <br />Armand.Delgado@VerizonWireless.Com <br />142 <br />Mail invoices to <br />Facility <br />Program record [ ] HMBP [ ] SQG HW [ ] LQG HW [ ] RCRA HW <br />created [ ] Tiered permit [ ] APSA [ ] CalARP [ ] UST <br />New PR#: <br />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: _ <br />Accounting: Reviewed by: Date: 3I1 g1] 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 PR0537234 JAMIE DE LA ROSA Active [ ] [ ] <br />2840 - AST EXEMPT FAC < 1,320 GAL PRO528893 MUNIAPPA NAIDU Inactive [ ] [ ] <br />)5 i'l Date: - (7 -15 <br />