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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 4:14:16PM CERS ID: 10144163 <br /> Submitted by: Debra Voth Email: Debra.Voth@verizonwireless.com Facility ID in CERS: FA0010704 <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 FA0010704 <br /> Facility name VERIZON -LOWER JONES TRACT(LUCEI Verizon Wireless Lower Jones Tract(Lucent 3 <br /> Site address 17720 W BACON ISLAND RD 17720 West Bacon Island Rd 103 <br /> City STOCKTON Stockton 104 <br /> Zip code 95219 95206 105 <br /> Facility phone 866-694-2415 8666942415 102 <br /> Facility mailing address 255 PARKSHORE DR 255 Parkshore Drive 108a <br /> City FOLSOM olsom 108b <br /> State CA Com^ 1080 <br /> Zip code 95630 95630 108d <br /> BILLING INFORMATION <br /> Contact name VERIZON -LOWER JONES TRACT(LUCEI Environmental Compliance 140 <br /> Address 255 PARKSHORE DR 255 Parkshore Drive 143 <br /> City FOLSOM F 144 <br /> State CA CA 145 <br /> Zip code 95630 3530~ 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 [ ] 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: xj Date: (0.14211 LA <br /> -------------------------------------- ---------- <br /> Accounting: <br /> -----------_ — -. ------ <br /> Accounting: Reviewed by: _LJ�2 Dater Clerical: ] File [ ] Create new file <br /> Acct b' edr [ ] Suroa<e verified 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 PR0512992 HAZA SAEED Active [ ] [ ] <br /> 2399-UNIFIED PROGRAM FAC STATE SURCHARGE FEE PRO510704 HAZ MAT SJC OES Inactive [ ] ( ] <br /> 2840-AST EXEMPT FAC <1,320 GAL PRO528899 STACY RIVERA Active, Exempt [ ] t ] <br />