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SAN JOAQUIN COUNTY ENVIRONMENTAL HEALTH DEPARTMENT <br /> Changes to EnvisionConnect by CERS Integration Wizard <br /> Date run: 6/13/2014 <br /> Submitted on: 6/1112014 1:24:48PM CERS ID: 10143163 <br /> Submitted by: Debra Voth Email: Debra.Voth@verizonwireless.com Facility ID in CERS: FA0010700 <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 FA0010700 <br /> Facility name VERIZON -ESCALON CELL SITE Verizon Wireless Escalon 3 <br /> Site address 27052 E HWY 120 27052 State Highway 120 103 <br /> City ESCALON Escalon 104 <br /> Zip code 95320 95320 105 <br /> Facility phone 209-838-1162 8666942415 102 <br /> Facility mailing address 2785 MITCHELL DR 255 Parkshore Drive 108a <br /> BLDG 9 - 1ST FLOOR <br /> City WALNUT CREEK Folsom 108b <br /> State CA CA 108e <br /> Zip code 94598 95630 108d <br /> BILLING INFORMATION <br /> Contact name VERIZON -ESCALON CELL SITE Environmental Compliance 140 <br /> Address 2785 MITCHELL DR 255 Parkshore Drive 143 <br /> City WALNUT CREEK Folsom 144 <br /> State CA CA 145 <br /> Zip code 94598 95630 146 <br /> Contact phone 925-279-6364 8666942415 1.41 <br /> Contact email Armand.Delgado@VerizonWireless.Com 142 <br /> Program record [ ] HMBP [ ] SQG HW [ ] LQG HW [ ] RCRA.HW New PR#: <br /> created [ ] Tiered permit [ ] APSA [ ] CaIARP [ ] 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: l/► Date: ' <br /> Accounting: Reviewed by: Date: Clerical: [ ] File [ ] Create new file <br /> -—————— [ l Ace ed [ ] 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 PR0512988 HAZA SAEED Active [ ] [ ] <br /> 2399-UNIFIER PROGRAM FAC STATE SURCHARGE FEE PRO510700 HAZ MAT SJC OES Inactive [ ] ] ] <br />