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RECEIVED <br /> UNIFIED PROGRAM CONSOLIDATED FORM <br /> FACILITY INFORMATION <br /> BUSINESS OWNER/OPERATOR IDENTIFICATION SAN JOAQUIN COUN <br /> 05/05/2009-08:24:10 AMEMERGENCY S RVICES <br /> Page of <br /> 1. IDENTIFICATION <br /> FACILITY ID# 13756 1 1 BEGINNING DATE NSA 100 ENDING DATE NSA 101 <br /> BUSINESS NAME(Same as FACILITY NAME or DBA-Doing Business As) 3 BUSINESS PHONE 102 <br /> AT&T MOBILITY-HWY 132&S BIRD RD 800-638-2822*2 <br /> BUSINESS SITE ADDRESS 103 BUSINESS FAX 102a <br /> 33856 S BEVIS RD Not Collected <br /> BUSINESS SITE CITY10 l ZIP CODE 105 COUNTY 108 <br /> TRACY C:A 95304 SAN JOAQUIN <br /> DUN&BRADSTREET 106 PRIMARY SIC 107 1 PRIMARY NAICS 107a <br /> 10-202-6754 4812 Not Collected <br /> BUSINESS MAILING ADDRESS 108a <br /> 4430 ROSEWOOD DR <br /> BUSINESS MAILING CITY 108 STATE 108cZIP CODE 108d <br /> PLEASANTON CA 94588 <br /> BUSINESS OPERATOR NAME 109 BUSINESS OPERATOR PHONE 110 <br /> AT&T MOBILITY 510-305-2553 <br /> 11. BUSINESS OWNER <br /> OWNER NAME(14) 111 1 OWNER PHONE(15) 112 <br /> CINGULAR&NEW CINGULAR DBA 510-305-2553 <br /> •m o_m>,Rnnrr rmv <br /> OWNER MAILING ADDRESS 113 <br /> 4430 ROSEWOOD DRIVE,BLDG.3,6TH FLR. <br /> OWNER MAILING CITY 114 STATE 115 ZIP CODE 116 <br /> PLEASANTON CA 94588 <br /> III. ENVIRONMENTAL CONTACT <br /> CONTACT NAME 117 1 CONTACT PHONE Hs <br /> S <br /> EH&S-ANDREW TAYLOR 925-823-6161 <br /> CONTACT MAILING ADDRESS 119 CONTACT EMAIL 11% <br /> 2600 CAMINO RAMON RM- stephen.lockert@stantec.cotn <br /> ar.AAA <br /> CONTACT MAILING CITY 120 STATE 121 ZIP CODE 121- <br /> SAN <br /> 2'_SAN RAMON CA 94583 <br /> IV. EMERGENCY CONTACTS <br /> NAME 123 NAME 128 <br /> ELLEN MAGME ROBEKT GAKZA <br /> TITLE 124 TITLE 129 <br /> COMPLIANCE MANAGER OPERATIONS MANAGER <br /> BUSINESS PHONE 510-305-2553 125 BUSINESS PHONE 925-468-8499 130 <br /> 24-HOUR PHONE * 126 24 HOUR PHONE 866-435-7347 131 <br /> 800-638-2822 2 <br /> PAGER# 510-305-2553 127 1 <br /> PAGER# 415-999-2672 132 <br /> ADDITIONAL LOCALLY COLLECTED INFORMATION: 133 <br /> COMPLETE PAGE 2 OF BUSINESS OWNER/OPERATOR IDENTIFICATION <br /> Certification: Based on my inquiry of those individuals responsible for obtaining the information,l certify under penalty of law by signing below or certifying by the <br /> established processes on the Administerting Agency's HMMP Compliance Website that 1 have personally examined and am familiar with the informaiton submitted and <br /> believe the information is true,accurate,and compitte. <br /> SIGNATURE OF OWNER/OPERATOR ESIGNA REPRESENTATIVE DATE 134 AME OF DOCUMENT PREPARER 135 <br /> VY 1 3 20 Sfan� <br /> NAME OF SIG t SKAIVDEFiS®N t 136 ITLE OF IGNER 137 <br /> UPCF(Rev.12/2007) <br />