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SAN JOAQUIN COUNTY ENVIRONMENTAL HEALTH DEPARTMENT <br /> Changes to EnvisionConnect by CERS Integration Wizard Date run: 6/13/2014 <br /> Submitted on: 6/12/2014 12:00:34PM CERS ID: 10144769 <br /> Submitted by: Debra Voth Email: Debra.Voth@verizonwireless.com Facility ID in CERS: FA0019363 <br /> Information prior to CIW processing Information after CIW processing CERS <br /> (current EC database) (current submittal) field <br /> OWNER INFORMATION <br /> Owner ID OW0008734 111 <br /> Owner name Verizon Wifeless Verizon Wireless <br /> Mailing address 255 Parkshore Drive 255 Parkshore Drive 113 <br /> 14 <br /> City Folsom Folsom 115 <br /> State CA CA <br /> ZIP code 95630 95630 116 <br /> Work phone 866-694-2415 8666942415 112 <br /> FACILITY FILE INFORMATION <br /> Facility ID FA0019363 <br /> Facility name VERIZON WIRELESS QUAIL LAKE Verizon Wireless Quail Lake 103 <br /> Site address 2323 GRAND CANAL BLVD 2323 Grand Canal Blvd 104 <br /> City STOCKTON Stockton <br /> Zip code 95207 95207 105 <br /> Facility phone 866-694-2415 8666942415 102 <br /> Facility mailing address 255 PARKVIEW DR 255 Parkshore Drive 108a <br /> City FOLSOM om 108b <br /> State CA CA, 108c <br /> Zip code 95630 95630 108d <br /> BILLING INFORMATION <br /> Contact name VERIZON WIRELESS QUAIL LAKE Environmental Compliance 143 <br /> Address 255 PARKVIEW DR 255 Parkshore Drive <br /> City FOLSOM 1=. so <br /> nlm 144 <br /> State CA CA- 145 <br /> Zip code 95630 95630 146 <br /> Contact phone Not Specified 8666942415 141 <br /> Contact email p Arm and.Del gado@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: 6 Date: Q41Q410T Clerical: File [ ] Create new file <br /> [ ] Acct bills> Surchar e'Gerified By:------------------------------Date___F <br /> ----------- <br /> T TIVE PROGF RECORDS PRIOR TO PROCESSING THROUGH CIW <br /> Program Element and Description Record ID Employee name Status Reactivated Inactivated <br /> 9926-HMBP-Unstaffed Network Location PR0538218 LOWELLALLEN Active I I I 1 <br /> 2840-AST EXEMPT FAC <1,320 GAL PR0528898 GARRETT BACKUS Active,Exempt [ ] [ l <br />