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SAN JOAQUI OUNTY ENVIRONMENTAL HEALTFWPARTMENT <br /> Changes to EnvisionConnect by CERS, Integration Wizard <br /> Date run: 3/17/2015 <br /> Submitted on: 1/23/2015 1:55:39PM CERS ID: 10144073 <br /> Submitted by: Debra Voth Email: Debra.Voth@verizonwireless.com Facility ID in CERS: FA0010912 <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 /> Folsom, CA 95630 Folsom, CA 95630 114, 115, 116 <br /> Work phone 866-694-2415 8666942415 112 <br /> FACILITY FILE INFORMATION <br /> Facility ID FA0010912 <br /> Facility name VERIZON WIRELESS -LINDEN Verizon Wireless Linden 3 <br /> Site address 19445 E HWY 26 19445 Hwy 26 $°"^�T.6-E-St- 103 <br /> City LINDEN Linden 104 <br /> ZIP code 95236 95236 105 <br /> Facility phone 925-527-9600 8666942415 102 <br /> Facility mailing address 2785 MITCHELL DR 255 Parkshore Drive 108a <br /> WALNUT CREEK, CA 94598 Folsom, CA 95630 108b,10ec,10ed <br /> BILLING INFORMATION <br /> Contact name VERIZON WIRELESS -LINDEN Environmental Compliance 140 <br /> Address 2785 MITCHELL DR 255 Parkshore Drive 143 <br /> WALNUT CREEK, CA 94598 Folsom, CA 95630 144, 145, 146 <br /> Contact phone 925-279-6364 8666942415 141 <br /> Contact email Armand.Del gado@VerizonWire less.Com 142 <br /> Mail invoices to Facility <br /> Program record ] ] HMBP [ ] SQG HW [ ] LQG HW [ ] RCRA HW New PR#: <br /> created [ ] Tiered permit [ ] APSA [ ] CaIARP [ ] 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: ar1 Date: ^ <br /> Accounting: Reviewed by: 0­1 Date: 3�I�! I� Clerical: [ ] File [ ] Relabel file [ ] Create new file <br /> [ ] Acct billed [ ] Surcharge verified By: __ Date: <br /> ACTIVE PROGRAM RECORDS PRIOR TO PROCESSING THROUGH CIW <br /> Program Element and Descri tion Record ID Employee name Status Reactivated Inactivated <br /> 1926-HMBP-Unstaffed Network Location PRO513200 JAMIE DE LA ROSA Active [ ] [ 1 <br /> 2399-UNIFIED PROGRAM FAC STATE SURCHARGE FEE PRO510912 HAZ MAT SJC OES Inactive [ ] I ] <br />