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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 11:17:39PM CERS ID: 10145777 <br />Submitted by: Debra Voth Email: Debra.Voth@verizonwireless.com Facility ID in CERS: FA0010695 <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 />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 />FACILITY FILE INFORMATION <br />Facility ID <br />FA0010695 <br />Facility name <br />Verizon Wireless Wilson Way <br />Verizon Wireless Wilson Way <br />3 <br />Site address <br />3975 N Wilson Way <br />3975 N Wilson Way <br />103 <br />City <br />Stockton <br />Stockton <br />104 <br />ZIP code <br />95205 <br />95205 <br />105 <br />Facility phone <br />866-694-2415 <br />8666942415 <br />102 <br />Facility mailing address <br />295 Parkshore Drive <br />295 Parkshore Drive <br />108a <br />Folsom, CA 95630 <br />Folsom, CA 95630 <br />108b, 108c, 1084 <br />BILLING INFORMATION <br />Contact name <br />Environmental Compliance <br />Environmental Compliance <br />140 <br />Address <br />295 Parkshore Drive <br />295 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@VerizonWi re less. 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 [ ] CaIARP [ ] 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: Date: - b• k 1 <br />Accounting: Reviewed by: Date: 9��7 Clerical: [ ] File [ ] Relabel file [ ] Create new file <br />[ ] Acct billed [ ] Surcharge verified By: Date: <br />ACTIVE PROGRAM RECORDS PRIOR TO PROCESSING THROUGH CIW <br />1�,�1.4-1 2 Record ID Employee name Status Reactivated Inactivated <br />- HMBP-Common Materialsf2'chem units PR0512983 HAZA SAEED Active [ ] [ ] <br />2399 - UNIFIED PROGRAM FAC STATE SURCHARGE FEE PR0510695 HAZ MAT SJC OES Inactive [ ] [ ] <br />