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SAN JOAQUIN COUNTY ENVIRONMENTAL HEALTH DEPARTMENT <br />Changes to EnvisionConnect by CERS Integration Wizard <br />Date run: 1/6/2017 <br />Submitted on: 1/3/2017 11:15:56PM <br />Submitted by: Debra Voth Email: Debra.Voth@verizonwireless.com <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 />Number of Facilities for this Owner : 89 <br />OW0008734 <br />Verizon Wireless <br />295 Parkshore Drive <br />Folsom, CA 95630 <br />866-694-2415 <br />FACILITY FILE INFORMATION <br />Facility ID FA0022079 <br />Facility name Verizon Wireless West Valley Mall <br />Site address 12352 W Larch Rd <br />City Tracy <br />ZIP code 95304 <br />Facility phone 866-694-2415 <br />Facility mailing address 295 Parkshore Drive <br />Folsom, CA 95630 <br />BILLING INFORMATION <br />Contact name Environmental Compliance <br />Address 295 Parkshore Drive <br />Folsom, CA 95630 <br />Contact phone 866-694-2415 <br />Contact email Armand.Delgado@VerizonWireless.Com <br />Mail invoices to Account <br />CERS ID: 10145725 <br />Facility ID in CERS: FA0022079 <br />Information after CIW processing CERS <br />(current submittal) field <br />Verizon Wireless <br />111 <br />295 Parkshore Drive <br />113 <br />Folsom, CA 95630 <br />114, 115, 116 <br />8666942415 <br />112 <br />Verizon Wireless West Valley Mall 3 <br />12352 W Larch Rd 103 <br />Tracy 104 <br />95304 105 <br />8666942415 102 <br />295 Parkshore Drive 108a <br />Folsom, CA 95630 108b, 108c, 1080 <br />Environmental Compliance 140 <br />295 Parkshore Drive 143 <br />Folsom, CA 95630 144, 145, 146 <br />8666942415 141 <br />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: Date: <br />Accounting: Reviewed by: Date: f Iq/11, Clerical: [ ] File [ ] Relabel file [ ] Create new file <br />[ ] Acct billed [ ] Surcharge verified By: Date: <br />ACTIVE PROGRAM RECORDS PRIOR TO PROCESSING THROUGH CIW <br />Record ID Employee name Status Reactivated Inactivated <br />1,926 - HMBP-Common Materia)4 chem units PR0538207 HAZA SAEED Active [ ] [ ] <br />