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R T=r;=1A <br />UN (DOCS <br />FACILITY INFORMATION JAN 12 201 <br />BUSINESS OWNER/OPERATOR IDENTIFICATION PAGE <br />0 N COU <br />I. IDENTIFICATION <br />FACILITY ID # <br />1. <br />BEGINNING DATE 100. <br />ENDING DATE 101. <br />(Agency Use On1j ) <br />BUSINESS NAME (Same as Facility Name or DBA --Doing Business As) } <br />BUSINESS PHONE W <br />T -MOBILE WEST CORPORATION SITE ID#SC07409A <br />UNMANNED FACILITY <br />BUSINESS SITE ADDRESS 103. <br />78 WEST ATLEE STREET <br />BUSINESS FAX 102° <br />UNMANNED FACILITY <br />BUSINESS SITE CITY 104. <br />ZIP CODE 105 <br />COUNTY 108. <br />STOCKTON <br />CA <br />95204 <br />SAN JOAQUIN <br />DUN _& BRADSTREET 106. <br />06-632-8376 <br />PRIMARY S[C 107. <br />PRIMARY NAICS 1078. <br />517212 <br />4812 <br />1 <br />BUSINESS MAILING ADDRESS 108a. <br />1755 CREEKSIDE OAKS, SUITE 190 <br />BUSINESS MAILING CITY 108b. <br />I STATE CA 108. I <br />ZIP CODE 95833 load. <br />SACRAMENTO <br />BUSINESS OPERATOR NAME 109_ <br />BUSINESS OPERATOR PHONE, 110. <br />T -MOBILE WEST CORPORATION <br />425 383-4000 <br />II. BUSINESS OWNER <br />OWNER NAME T -MOBILE WEST CORPORATION 111. <br />OWNERPHONE 11- <br />425 383-4000 <br />OWNER MAILING ADDRESS 113. <br />12920 SE 38TH STREET <br />1 1 ° <br />OWNER MAILING CITY <br />STATE WA t 15. <br />ZIP CODE 98006 116 <br />BELLEVUE <br />III. ENVIRONMENTAL CONTACT <br />CONTACT NAME 1)7 <br />CONTACT PHONE 118. <br />MICHELLE STEFFLER <br />(916)643-8979 <br />CONTACT MAILING ADDRESS 119• <br />CONTACT EMAIL 119.. <br />1755 CREEKSIDE OAKS, SUITE 190 <br />CONTACT MAILING CITY SACRAMENTO 120. <br />STATE CA 121. <br />zIP CODE 95833 <br />-PRIMARY- IV. EMERGENCY <br />CONTACTS -SECONDARY- <br />NAME 1-'3. <br />NAME 128• <br />NICHOLAS H. FISCHER <br />T -MOBILE WEST NOCC <br />TITLE 124. <br />TITLE I29. <br />MANAGER- ENGINEERING <br />N/A <br />BUSINESS PHONE 125. <br />BUSINESS PHONE 130. <br />(916)622-0137 <br />(888)662-4662 <br />24-HOUR PHONE 126. <br />24-HOUR PHONE 131, <br />(888)662-4662 <br />(888)662-4662 <br />127• <br />PAGER # N/A <br />PAGER # 132. <br />N/A <br />ADDITIONAL LOCALLY COLLECTED INFORMATION: 133. <br />Billing Address: 1755 CREEKSIDE OAKS, SUITE 190 SACRAMENTO„ CA 95833 <br />Property Owner: Phone No.: ( ) <br />Certifi tion: sedo 3 my inquiry of those individuals responsible for obtaining the information, I certify under penalty of law that I have personally examined and <br />am familia wit he in ation submitted and believe the information is true, accurate, and complete. <br />SIGNAT[ 0 - RJJDPERAT DESIGNATED REPRESENTATIVE <br />DATE 134. <br />NAME OF DOCUMENT PREPARER 135. <br />12/16/2011 <br />KELLY MICHAELS OF EAS <br />1 <br />NAME OF SI R print) 136. <br />TITLE OF SIGNER 137. <br />NICHPLIAS H. FISCHER <br />MANAGER- ENGINEERING <br />UN -020 V www.unidGcs.org 5/17 -Rev. 12/14/10 <br />c.rs <br />