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SAN JOAQU COUNTY ENVIRONMENTAL HEALTNEEPARTMENT <br /> Changes to EnvisionConnect by CERS Integration Wizard Date run: 6/13/2014 <br /> Submitted on: 4/17/2014 10:40:23AM CERS ID: 10144375 <br /> Submitted by: Debra Voth Email: Debra.Voth@verizonwireless.com Facility ID in CERS: FA0022080 <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 FA0022080 <br /> Facility name VERIZON WIRELESS MOUNTAIN HOUSE Verizon Wireless Mountain House 3 <br /> Site address 20700 MOUNTAIN HOUSE PKWY 20700 Mountain House Parkway 103 <br /> City TRACY Tracy 104 <br /> Zip code 95304 95304 105 <br /> Facility phone 866-694-2415 8666942415 102 <br /> Facility mailing address 255 PARKSHORE DR 255 Parkshore Drive 108a <br /> City FOLSOM Folsom 108b <br /> State CA CA 108c <br /> Zip code 95630 95630 108d <br /> BILLING INFORMATION <br /> Contact name VERIZON WIRELESS MOUNTAIN HOUSE Environmental Compliance 140 <br /> Address 255 PARKSHORE DR 255 Parkshore Drive 143 <br /> City FOLSOM Folsom 144 <br /> State CA CA 145 <br /> Zip code 95630 95630 146 <br /> Contact phone Not Specified 8666942415 141 <br /> Contact email /i ,I Armand.Delgado@VerizonWireless.Com 142 <br /> Program record [ ] HMBP [ ] SQ 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 by: k n' Date: <br /> Accounting: Reviewed by: �Date: ARLd Clerical: File ( ] Create new file <br /> [ ] Acct d [ ] Surcharge rified By: — Date_ <br /> -- -------- -- -- <br /> ACTIVE PROGRAW ECORDS PRIOR TO PROCESSING THROUGH CIW <br /> Program Element and Description Record ID Employee name Status Reactivated Inactivated <br /> 1926-HMBP-Unstaffed Network Location PR0538208 HAZA SAEED Active I I I I <br />