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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: 6/12/2014 11:15:33AM CERS ID: 10144259 <br /> Submitted by: Debra Voth Email: Debra.Voth@verizonwireless.com Facility ID in CERS: FA0019355 <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 FA0019355 <br /> Facility name VERIZON WIRELESS - MCMULLIN Verizon Wireless McMullin 3 <br /> Site address 24442 SAIR PORT WAY 24442 SAirport Way 103 <br /> City MANTECA Manteca 104 <br /> Zip code 95337 95337 105 <br /> Facility phone 925-527-9600 8666942415 102 <br /> Facility mailing address 2785 MITCHELL DR BLDG 9 1ST FLOOR 255 Pre 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 - MCMULLIN Environmental Compliance 140 <br /> Address 2785 MITCHELL DR BLDG 9 1ST FLOOR 255 Park Dr've 143 <br /> City WALNUT CREEK F-OlseRr- 144 <br /> State CA CA 145 <br /> Zip code 94598 95630 146 <br /> Contact phone Not Specified 8666942415 141 <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: Date: &,13 A <br /> — <br /> Accounting: Reviewed by: yl J Date: �5 1 Clerical: File [ ] Create new file <br /> [ ] Acct Aled- [ ] Surchar fled By: Date: <br /> --------- <br /> ------ <br /> ------- ----------- -- ------------------- <br /> ACTIVE PROGRA RECORDS PRIOR TO PROCESSING THROUGH CIW <br /> Program Element and Description Record ID Employee name Status Reactivated Inactivated <br /> 1926-HMBP-Unstaffed Network Location PRO537216 HAZA SAEED Active [ ] [ ] <br /> 2840-AST EXEMPT FAC a 1,320 GAL PRO528887 MUNIAPPA NAIDU Active,Exempt [ ] [ ] <br />