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BUSINESS OWNER/OPERATOR IDENTIFICATION FORM <br /> 7/16/2008 11 ACCOL111t #: 12791 <br /> I. IDENTIFICATION <br /> BUSINESS NAME (4) AT&T MOBILITY-N MANTECA BUSINESS PHONE(5) 800-638-2822 <br /> IWOS1 <br /> SITE ADDRESS (6) 12771 FICASTLE <br /> RD <br /> Street No. Direction Street Name Street Type ,t/I31d'_%Suite <br /> CITY (7) IMANTECA STATE(8) CA ZIP(9) 95336 <br /> DUN& (10) 10-202-6754 SIC CODE(4 DIGIT#)(11) 4812 <br /> BRADSTREET <br /> OPERATOR (12)AT&T MOBILITY OPERATOR PHONE(13) 916-285-4201 <br /> NAME <br /> H.BUSINESS OWNER <br /> OWNER NAME(14) CINGULAR & NEW CINGULAR I OWNER PHONE(15)1916-285-4201 <br /> DBA AT&T MOBILITY <br /> OWNER MAILING ADDRESS(16) 3851 N. FREEWAY BLVD. <br /> (If different from site address) <br /> CITY(17) SACRAMENTO STATE(18) F:1 <br /> ZIP(i 9) 195834 <br /> III. ENVIRONMENTAL CONTACT <br /> CONTACT NAME(20) FH&S -JESSICA NIELSEN CONTACT PHONE(21) 916-285-4201 <br /> MAILING ADDRESS(22) <br /> (If different from site address)13851 N FREEWAY BLVD <br /> Street No. Direction Street Name Street Type Apt/Bldg/Suite <br /> CITY(23) SACRAMENTO STATE(24) 1�ij <br /> ZIP(25) 95834 <br /> Primary IV. EMERGENCY CONTACTS Secondary <br /> NAME(26) ELLEN MAGNIE NAME(3 1) GHIZAL ABAWI <br /> TITLE(27) COMPLIANCE MANAGER TITLE(32) COMPLIANCE ANALYST II <br /> BUSINESS PHONE(28) 510-305-2553 BUSINESS PHONE(33) Fi5-468-8553 <br /> 24-HOUR PHONE(29) 1800-638-2822 24-HOUR PHONE(34) 800-638-2822 <br /> PAGER#(30) 1510-305-2553 PAGER#(35) 1925-286-3207 <br /> EXTREMELY HAZARDOUS SUBSTANCES (EHS) <br /> ON-SITE EHS (36) YE$ If yes,and above Threshold Planning Quantities,attach a sheet of paper with a general <br /> description of the process and principle equipment involved with the EHS. <br /> ADDITIONAL LOCALLY COLLECTED INFORMATION(37) Provide information requested on the 2nd page of this form <br /> NAME OF DOCUMENT PREPARER(38) ISTANTEC CONSULTING INC. <br /> NAME OF OWNER/OPERATOR(39) NEW CINGULAR WIRELESS DATE(40) <br /> PCS, LLC DBA AT&T <br />