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SAN JOAQUII OUNTY ENVIRONMENTAL HEALTH PARTMENT <br /> Changes to EnvisionConnect by CERS Integration Wizard Date run: 6/13/2014 <br /> Submitted on: 6/12/2014 11:46:54AM CERS ID: 10144653 <br /> Submitted by: Debra Voth Email: Debra.Voth@verizonwireless.com Facility ID in CERS: FA0019328 <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 FA0019328 <br /> Facility name VERIZON WIRELESS -PATTERSON PASS Verizon Wireless Patterson Pass 3 <br /> Site address 24371 PATTERSON PASS RD 24371 Patterson Pass Road 103 <br /> City TRACY Tracy 104 <br /> Zip code 95376 95377 105 <br /> Facility phone 925-527-9600 8666942415 102 <br /> Facility mailing address 2785 MITCHELL DR BLDG 9 1ST FL 255 Parkshore Drive 108a <br /> City WALNUT CREEK Folsom 108b <br /> State CA CA 1080 <br /> Zip code 94598 95630 108d <br /> BILLING INFORMATION <br /> Contact name VERIZON WIRELESS-PATTERSON PASS Environmental Compliance 140 <br /> Address 2785 MITCHELL DR BLDG 9 1 ST FL 255 Parkshore Drive 143 <br /> City WALNUT CREEK Folsom 144 <br /> State CA CA 145 <br /> Zip code 94598 95630 146 <br /> Contact phone Not Specified 8666942415 141 <br /> Contact email p Armand.Delgado@VerizonWireless.Com 142 <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 by: PIA Date: <br /> Accounting: Reviewed by: Date: "1//11 4 [ Clerical: J;�File [ ] Create new file <br /> filled [ ] Surc a verified By: — Date_ <br /> ACTIVE PRO M RECORDS PRIOR TO PROCESSING THROUGH CIW <br /> Program Element and Description Record ID Employee name Status Reactivated Inactivated <br /> 1926-HMBP-Unstaffed Network Location PR0510910 HAZA SAEED Active [ 1 [ 1 <br /> 2224-HAZ MAT BUSINESS PLAN AUTHORIZATION PR0513198 HAZ MAT SJC OES Inactive [ ] I 1 <br /> 2840-AST EXEMPT FAC <1,320 GAL PR0528848 THUY TRAN Active,Exempt [ ] I 1 <br />