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SAN JOAQUWOUNTY ENVIRONMENTAL HEALT EPARTMENT <br /> Changes to EnvisionConnect by CERS Integration Wizard Date run: 3/17/2015 <br /> Submitted on: 1/23/2015 2:03:04PM CERS ID: 10144371 <br /> Submitted by: Debra Voth Email: Debra.Voth@verizonwireless.com Facility ID in CERS: FA0019327 <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 FA0019327 <br /> Facility name VERIZON WIRELESS -MOSSDALE SITE Verizon Wireless Mossdale 3 <br /> Site address 1286 E MADRUGA RD 1375-E-Madruga Rd 1286 E. Madruga Rd 103 <br /> City LATHROP Lathrop II 104 <br /> ZIP code 95330 95330 105 <br /> Facility phone 925-527-9600 8666942415 ii t4A) 102 <br /> /I <br /> Facility mailing address 2785 MITCHELL DR BLDG 9 IST FL 255 Parkshore Drive V 108a <br /> WALNUT CREEK, CA 94598 Folsom, CA 95630 108b,108c,108d <br /> BILLING INFORMATION <br /> Contact name VERIZON WIRELESS-MOSSDALE SITE Environmental Compliance 140 <br /> Address 2785 MITCHELL DR BLDG 9 1 ST FL 255 Parkshore Drive 143 <br /> WALNUT CREEK, CA 94598 Folsom, CA 95630 144, 145, 146 <br /> Contact phone Not Specified 8666942415 141 <br /> Contact email Armand.Delgado@VerizonWireless.Com 142 <br /> Mail invoices to Facility <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 /> Processed through CERS Integration Wizard <br /> A, '0 by: CiSm Date: 'Y17 —]15 <br /> Accounting: Reviewed by: W Date: - gI I 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 PR0512994 HAZA SAEED Active [ ] [ ] <br /> 2399-UNIFIED PROGRAM FAC STATE SURCHARGE FEE PR0510706 HAZ MAT SJC DES Inactive [ ] [ ] <br /> 2a40-AST EXEMPT FAC <1,320 GAL PR0528847 MUNIAPPA NAIDU Inactive [ ] [ ] <br />