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SAN JOAQUi, COUNTY ENVIRONMENTAL HEALTH .jEPARTMENT <br />Changes to EnvisionConnect by CERS Integration Wizard <br />Date run: 3/17/2015 <br />Submitted on: 1/23/2015 1:56:16PM <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 />FA0021381 <br />Facility name <br />VERIZON WIRELESS - LIVE OAK <br />Site address <br />9303 E LIVE OAK RD <br />City <br />STOCKTON <br />ZIP code <br />95215 <br />Facility phone <br />925-527-9600 <br />CERS ID: 10144085 <br />Facility ID in CERS: FA0021381 <br />Information after CIW processing CERS <br />(current submittal) field <br />Verizon Wireless 111 <br />255 Parkshore Drive 113 <br />Folsom, CA 95630 114, 115, 116 <br />8666942415 112 <br />Verizon Wireless Live Oak Road 3 <br />9303 East Live Oak Rd .lac! ne wy ; 103 <br />Stockton 104 <br />95215 105 <br />8666942415 102 <br />Facility mailing address <br />2785 MITCHELL DR BLDG 9 1ST FLR <br />255 Parkshore Drive <br />108a <br />WALNUT CREEK, CA 94598 <br />Folsom, CA 95630 <br />108b, 108c, 108d <br />BILLING INFORMATION <br />Contact name <br />VERIZON WIRELESS - LIVE OAK <br />Environmental Compliance <br />140 <br />Address <br />2785 MITCHELL DR BLDG 9 1ST FLR <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: Date: <br />Accounting: Reviewed by: _1,iP' Date: Z -' /l ell S 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 PR0537254 ROBERT LOPEZ Active I I I I <br />