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SAN JOAQUIK . OUNTY ENVIRONMENTAL HEALTH--PARTMENT <br />Changes to EnvisionConnect by CERS Integration Wizard <br />Date run: 4/9/2015 <br />Submitted on: 1/23/2015 2:21:41PM CERS ID: 10600393 <br />Submitted by: Debra Voth Email: Debra.Voth@verizonwireless.com Facility ID in CERS: incorrect <br />OWNER INFORMATION <br />Owner ID <br />Owner name <br />Mailing address <br />Work phone <br />Information prior to CIW processing <br />(current EC database) <br />OW0020482 <br />Verizon Wireless <br />255 Parkshore Drive <br />Folsom, CA 95630 <br />866-694-2415 <br />FACILITY FILE INFORMATION <br />Facility ID <br />FA0022728 <br />Facility name <br />Verizon Wireless Victoria Island Farms <br />Site address <br />16021 W STATE ROUTE 4 <br />City <br />Stockton <br />ZIP code <br />95206 <br />Facility phone <br />866-694-2415 <br />Information after CIW processing CERS <br />(current submittal) field <br />Verizon Wireless 111 <br />255 Parkshore Drive 113 <br />Folsom, CA 95630 114, 115, 116 <br />8666942415 112 <br />Verizon Wireless Victoria Island Farms 3 <br />16021 W State Route 4 103 <br />Stockton 104 <br />95206 105 <br />8666942415 102 <br />Facility mailing address <br />255 Parkshore Drive <br />255 Parkshore Drive <br />108a <br />Folsom, CA 95630 <br />Folsom, CA 95630 <br />108b, 108c, 1084 <br />BILLING INFORMATION <br />Contact name <br />Verizon Wireless Victoria Island Farms <br />Environmental Compliance <br />140 <br />Address <br />255 Parkshore Drive <br />255 Parkshore Drive <br />143 <br />Folsom, CA 95630 <br />Folsom, CA 95630 <br />144, 145, 146 <br />Contact phone <br />866-694-2415 <br />8666942415 <br />141 <br />Contact email <br />Armand.Delgado@VerizonWireless.com <br />Armand.Delgado@VerizonWireless.com <br />142 <br />Mail invoices to <br />Account ./ <br />Program record [ ] HMBP [ ] SQG HW [ ] LQG HW [ ] RCRA HW <br />created [ ] Tiered permit [ ] APSA [ ] CalARP [ ] UST <br />New PR#: _ <br />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: ''i'n Date: 1 <br />---------------------------------------------------- <br />Accounting: Reviewed by: Date: (� Clerical: [ ] File [ ] Relabel file [ ] Create new file <br />[ ] Acct billed [ ] Surcharge 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 />1921 - HMBP-Regular-Primary Location PR0539726 ROBERT LOPEZ Active [] [] <br />