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SAN JOAQUIN COUNTY ENVIRONMENTAL HEALTH DEPARTMENT <br /> Changes to EnvisionConnect by CERS Integration Wizard Date run: 6/13/2014 <br /> Submitted on: 6/11/2014 1:41:31 PM CERS ID: 10145397 <br /> Submitted by: Debra Voth Email: Debra.Voth@verizonwireless.com Facility ID in CERS: FA0011271 <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 FA0011271 <br /> Facility name VERIZON WIRELESS-STK/MOD SWITCH Verizon Wireless Stockton Modesto MTSO ( 3 <br /> Site address 3202 S MOURFIELD AVE 3202 Mourfield Rd 103 <br /> City STOCKTON Stockto 104 <br /> Zip code 95206 %95202 105 <br /> Facility phone 925-527-9600 86 6942415 102 <br /> Facility mailing address 2785 MITCHELL DR BLDG 9 1 ST FLOOR255 Parksh- re 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-STK/MOD SWITCH 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 925-279-6364 8666942415 141 <br /> Contact email Q Armand.Delgado@VerizonWireless.Corn 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 /> W' <br /> Processed through CERS Integration Wizard by: " Date: � I-�'1N <br /> ----------------LI-) <br /> --------- <br /> Accounting: Reviewed by:L�Date: ! 7 V/1 V1 File [ ] Create new file <br /> [ ] Acct bifid [ ] Surch .e------ -- -----_--_ — Date_ <br /> /ACTIVE PROGRAMRECORDS PRIOR TO PROCESSING THROUGH CIW <br /> Program Element and Description Record ID Employee name Status Reactivated Inactivated <br /> 1926-HMBP-Unstaffed Network Location PR0511271 LOWELL ALLEN Active [ ] [ ] <br /> 2224-HAZ MAT BUSINESS PLAN AUTHORIZATION PR0513559 HAZ MAT SJC OES Inactive [ ] [ ] <br /> 2831 -AST FAC >/=1,320-<10 K GAL CUMULATIVE PR0517488 STACY RIVERA Active, Exempt [ ] [ ] <br />