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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: 611212014 1:32:32PM CERS ID: 10145637 <br /> Submitted by: Debra Voth Email: Debra.Voth@verizonwireless.com Facility ID in CERS: FA0019365 <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 FA0019365 <br /> Facility name VERIZON WIRELESS -VICTORY RD Verizon Wireless Victory Road 3 <br /> Site address 17793 S VICTORY RD 17793 S. Victory Rd 103 <br /> City ESCALON Escalon 104 <br /> Zip code 95361 95320 105 <br /> Facility phone 925-5279600 8666942415 102 <br /> Facility mailing address 2785 MITCHELL DR BLDG 9 1ST FLOOR 255 Parkshore Drive 108a <br /> City WALNUT CREEK Folsom 108b <br /> State CA CA 108c <br /> Zip code 94598 95630 108d <br /> BILLING INFORMATION <br /> Contact name VERIZON WIRELESS -VICTORY RD Environmental Compliance 140 <br /> Address 2785 MITCHELL DR BLDG 9 1ST FLOOR 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 F-p ✓ Armand.Delgado@VerizonWireless.Com 142 <br /> Program record [ ] HMBP [ ] SOG HW [ ] LOG HW [ ] RCRA HW New PR#: <br /> created [ J Tiered permit [ J APSA [ J CalARP [ ] UST New PE: <br /> Assigned to: <br /> Please bill: [ ] full calendar year [ ] prorate this calendar year [ J !next calendar year [ ] exempt from billing <br /> Processed through CERS Integration Wizard by: Date: +O'��`1 -1 <br /> - - � - - -- -- -- --------------------- <br /> Accounting: Reviewed by: Date: Clerical: /File [ ] Create new file <br /> [ ] Ac <br /> ed_ <br /> [ ] Sur cha erlfied By: Date: <br /> — ---- --- — ----- <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 PR0537223 HAZA SAEED Active [ ] [ ] <br /> 2840-AST FXEMPT FAC < 1,320 GAL PRO528902 MUNIAPPA NAIDU Active, Exempt <br />