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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 1:32:32PM CERS ID: 10145637 <br /> Submitted by: Debra Voth Email: Debra.Voth@verizonwireless.com Facility ID in CERS: FA0019365 <br /> Information prior to CM 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 FA0019365 <br /> Facility name VERIZON WIRELESS-VICTORY RD Verizon Wireless Victory Road 3 <br /> Site address 17793 S VICTORY RD 17793 S. Victory Rd 103 <br /> City ESCALON Escalon 104 <br /> Zip code 95361 95320 105 <br /> Facility phone 925-527-9600 8666942415 102 <br /> Facility mailing address 2785 MITCHELL DR BLDG 9 1 ST FLOOR 255 Parkshore Drive 108a <br /> City WALNUT CREEK Folsom 108b <br /> State CA CA 1080 <br /> Zip code 94598 95630 108d <br /> BILLING INFORMATION <br /> Contact name VERIZON WIRELESS-VICTORY RD Environmental Compliance 140 <br /> Address 2785 MITCHELL DR BLDG 9 1ST FLOOR 255 Parkshore Drive 143 <br /> City WALNUT CREEK Folsom 144 <br /> State CA CA 145 <br /> Zip code 94598 95630 146 <br /> Contact phone Not Specified 8666942415 141 <br /> Contact email1:7- <br /> A V/ Armand.Delgado@VerizonWireless.Com 142 <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: �—Date: 6-001 <br /> --------------------------------- <br /> Accounting: Reviewed by:. Date: Clerical: /File [ ] Create new file <br /> ---- [ ] 1. <br /> Ac ' ed [ ] Surch e-----------rifledBy: Date_ <br /> ACTIVE PROGRAM RECORDS PRIOR TO PROCESSING THROUGH CIW <br /> Program Element and Description Record ID Employee name Status Reactivated Inactivated <br /> 1926-HMBP-Unstatfed Network Location PR0537223 HAZA SAEED Active [ ] [ ] <br /> 2840-AST EXEMPT FAC <1,320 GAL PRO628902 MUNIAPPA NAIDU Active, Exempt [ ] [ ] <br />