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RECEIVED <br /> MO 212 <br /> UNIFIED PROGRAM CONSOLIDATED FORM <br /> FACILITY INFORMATION <br /> BUSINESS OWNER/OPERATOR IDENTIFICATION OFFlCE N EMER6IE CO JNTY <br /> SERVICES <br /> -08:26:37 AM <br /> Page of <br /> I. IDENTIFICATION <br /> FACILITY ID# 13757 1 1 BEGINNING DATE NSA 100 ENDING DATE N/A 101 <br /> BUSINESS NAME(Same as FACILITY NAME or DBA-Doing Business As) 3 BUSINESS PHONE 102 <br /> AT&T MOBILITY-HWY 12 LOCKEFORD 800-638-2822*2 <br /> BUSIN SSITEADDRESS 103 BUSINESS FAX 102a <br /> 14700 E HWY 88 Not Collected <br /> BUSINESS SITE CITY10 1 ZIP CODE 105 COUNTY 108 <br /> LOCKEFORD CA 95237 SAN JOAQUIN <br /> DUN&BRADSTREET 106 PRIMARY SIC 107 PRIMARY NAICS 107a <br /> 10-202-6754 4812 Not Collected <br /> BUSINESS MAILING ADDRESS 108a <br /> 4430 ROSEWODD DR <br /> BUSINESS MAILING CITY 108t STATE 108cZIP CODE 108d <br /> PLEASANTON CA 194588 <br /> BUSINESS OPERATOR NAME 109 BUSINESS OPERATOR PHONE 110 <br /> AT&T MOBILITY 510-305-2553 <br /> II. BUSINESS OWNER <br /> OWNER NAME(14) 1 1 1 1 OWNER PHONE(15) 11-1 <br /> CINGULAR&NEW CINGULAR DBA 510-305-2553 <br /> A T O_T 119! "TT TT[7 <br /> OWNER MAILING ADDRESS 113 <br /> 4430 ROSEWOOD DRIVE,BLDG3,6TH 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 118 <br /> EH&S-ANDREW TAYLOR 925-823-6161 <br /> CONTACT MAILING ADDRESS 119 CONTACT EMAIL 119a <br /> 2600 CAMINO RAMON RM stephen.lockert@stantec.com <br /> ornnn <br /> CONTACT MAILING CITY 120 STATE 121 ZIP CODE 122 <br /> SAN RAMON CA 94583 <br /> IV. EMERGENCY CONTACTS <br /> NAME ELLEN MAGNIE 123 NAME ROBERT GARZA 128 <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 800-638-2822*2 126 24-HOUR PHONE 800-566-9347 131 <br /> PAGER# 510-305-2553 127 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 com let <br /> SIGNATURE OF OWNER/O TOR O IONATED REPRESENTATIVE �tjTFy AME OF DOCUMENT PREPARER 135 <br /> A`( 1 J SAc.ot.SJ�� <br /> NAMEOF SIGN VE SKANDEHtiO136 17ITLE OF SIGNER 137 <br /> 61f-, 4-� T <br /> UPCF(Rev.12/2007) <br />