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SAN JOAQUIR OUNTY ENVIRONMENTAL HEALTHWARTMENT <br /> Changes to EnvisionConnect by CERS Integration Wizard <br /> Date run: 6/13/2014 <br /> Submitted on: 6/1212014 11:27:42AM CERS ID: 10144367 <br /> Submitted by: Debra Voth Email: Debra.Voth@verizonwireless.com Facility ID in CERS: FA0021407 <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 FA0021407 <br /> Facility name VERIZON WIRELESS - MOSHER CREEK Verizon Wireless Mosher Creek 3 <br /> Site address 9025 WEST LN 9025 West Ln 103 <br /> City STOCKTON Stockton 104 <br /> Zip code 95210 95210 105 <br /> Facility phone 925-527-9600 8666942415 102 <br /> Facility mailing address 2785 MITCHELL DR BLDG 9 1ST FLR 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- MOSHER CREEK Environmental Compliance 140 <br /> Address 2785 MITCHELL DR BLDG 9 IST FLR 255 Parks 143 <br /> City WALNUT CREEK Foisor 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 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 /> ` <br /> Processed through CERS Integration Wizard by: NA Date: Lo <br /> Accounting: Reviewed by: L6 Date: ! 1`�' Clerical: /1 File [ ] Create new file <br /> [ ] Acct b [ ] Surch verified By: Date: <br /> CTIVE PROGRAM RECORDS PRIOR TO PROCESSING THROUGH CIW <br /> Program Element and Description Record ID Employee name Status Reactivated Inactivated <br /> 1926-HMBP-Unstaffed Network Location PRO537291 HAZA SA€ED Active [ ] [ ] <br />