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SAN JOAQUIN COUNTY ENVIRONMENTAL HEALTH DEPARTMENT <br /> Changes to EnvisionConnect by CERS Integration Wizard <br /> Date run: 6/13/2014 <br /> Submitted on: 6/12/2014 11:19:31AM CERS ID: 10144287 <br /> Submitted by: Debra Voth Email: Debra.Voth@verizonwireless.conm Facility ID in CERS: FA0019358 <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 /> City Folsom Folsom 114 <br /> State CA CA 115 <br /> ZIP code 95630 95630 116 <br /> Work phone 866-694-2415 8666942415 112 <br /> FACILITY FILE INFORMATION <br /> Facility ID FA0019358 <br /> Facility name VERIZON WIRELESS -MICKE GROVE Verizon Wireless Micke Grove 3 <br /> Site address 3966 E SCOTTSDALE RD 3966 Scottsdale Rd 103 <br /> City LODI Lodi 104 <br /> Zip code 95240 95240 105 <br /> Facility phone 925-527-9600 8666942415 102 <br /> Facility mailing address 2785 MITCHELL DR BLDG 9 1ST FLOOR 255 Parkshore Drive 108a <br /> City WALNUT CREEK Folsom 108b <br /> State CA CA 108c <br /> Zip code 94598 95630 108d <br /> BILLING INFORMATION ` <br /> Contact name VERIZON WIRELESS- MICKE GROVE Environmental Compliance 140 <br /> Address 2785 MITCHELL DR BLDG 9 IST FLOOR 255 Parkshore Drive 143 <br /> City WALNUT CREEK IGslso 144 <br /> State CA CA 145 <br /> Zip code 94598 95630 146 <br /> Contact phone Not Specified 8666942415 141 <br /> Contact email Armand.Delgado@VerizonWireless.Com 142 <br /> Program record ( ] HMBP [ ] SQG [ ] 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: l/""' Date: t' �3•�� <br /> -------------------------------------- <br /> [ <br /> Accounting: Reviewed by: 1 —Dater Clerical: File ] Create new fife <br /> [ ] Acct bill d — [ ] Surchar 6rrified By: Date: <br /> — ------- -- — —— --- <br /> CTIVE PROG RECORDS PRIOR TO PROCESSING THROUGH CIW <br /> Program Element and Description Record ID Employee name Status Reactivated Inactivated <br /> 1926-HMBP-Unstaffed Network Location PR0537217 HAZA SAEED Active [ ] [ ] <br /> 2840-AST EXEMPT FAC <1,320 GAL PRO528891 ARIS VELOSO Active, Exempt [ ] [ ] <br />