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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: 6/11/2014 1:14:48PM CERS ID: 10143053 <br /> Submitted by: Debra Voth Email: Debra.Voth@verizonwireless.com Facility ID in CERS: FA0019361 <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 FA0019361 <br /> Facility name VERIZON WIRELESS E GRANT LINE (TR/ Verizon Wireless East Grant Line(Tracy) 3 <br /> Site address 724 E GRANT LINE RD 724 E Grant Line Rd 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 E GRANT LINE (TRF 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 866-694-2415 8666942415 141 <br /> Contact email Armand.Delgado@VerizonWireless.Com 142 <br /> Program record ( ] HMBP [ I 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 Wdard by: V-IJ Date: 4-AS•t K <br /> Accountin Reviewed b : Dater ------- Clerical: File <br /> ---------- <br /> g: y [ ] [ ] Create new file <br /> [ ] Acc ' ed [ ] Su rch nfied --By:— Date: <br /> —--————- give——— <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 PR0538217 LOWELLALLEN Active [ ] [ ] <br /> 2840-AST EXEMPT FAC <1,320 GAL PR0528895 THUY TRAN Active,Exempt [ ] [ ] <br />