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\�C%A`A RECEIVE <br /> UNIFIED PROGRAM CONSOLIDATED FORM <br /> FACILITY INFORMATION E N EMERGENCYSERVICES <br /> BUSINESS OWNER/OPERATOR IDENTIFICATI <br /> Pae 2 of 8 <br /> 1. IDENTIFICATION <br /> FIBUSINESS <br /> BEGINNING DATE Im ENDING DATE 1°l. <br /> — 2`07 11/2/2008 <br /> ) <br /> E(s.m*ea FAaL1TV NAMe33 BUSINESS PHONEs CA -American Tower Cor Site #82597ADDRESS <br /> 24550 N. State Route 88 Hiohway 04 ZIP CODE <br /> CITY CA <br /> Clements 95997 <br /> DUN&BRADSTREET 1W. SIC CODE(4 digit#) 107. <br /> 926396870 14813 iN <br /> COUNTY <br /> San Joaauin Ila <br /> BUSINESS OPERATOR NAME 109 I BUSINESS OPERATOR PHONE <br /> American Tower Cor oration028 <br /> II. BUSINESS OWNER <br /> OWNER NAME <br /> III, OWNER PHONE 112. <br /> American Tower Corporation 284 280 <br /> 3. <br /> OWNER MAILING ADDRESS <br /> PO Box 63604 <br /> CITY 114- STATE 115. ZIP CODE D6. <br /> Phoenix I AZ 082 <br /> III. ENVIRONMENTAL CONTACT <br /> CONTACT NAME CONTACT PHONE us. <br /> 14 cot Sand fur 0 119. <br /> ONTACT MAILING ADDRESS <br /> PO Box 63604 <br /> CITY <br /> aa. STATE 121, ZIP CODE 122. <br /> Phoenix I AZ 1 550 <br /> -PRIMARY- IV. EMERGENCY CONTACTS -SECONDARY- <br /> NAME 123. NAME 12s. <br /> Scot Sandefur Alarm Res onse Center <br /> TITLE 124. TITLE 129. <br /> Director. Environmental Health & Safety ATC 24-HR Alarm Comm. Center <br /> BUSINESS PHONE 125. BUSINESS PHONE 130, <br /> (602) 284-0280 ext (800) 830-3365 ext. <br /> 24-HOUR PHONE* im. 24-HOUR PHONE* 131 <br /> (602) 284-0280 ext 1 (800) 830-3365 ext- <br /> PAGER# 121. 1 PAGER# 132. <br /> ADDITIONAL LOCALLY COLLECTED INFORMATION: 133_ <br /> Billing Address: American Tower Corp. PO Box 63604 Phoenix, AZ 85082 <br /> Property Owner: Gregg & Colleen Lewis Phone No.: ( ) <br /> 1610 W. Lodi Avenue Lodi, CA 95242 <br /> Certification: Based on my inquiry of thos V u responsible for obtaining the informadip,I certify under penalty of law that I have personally examined and <br /> am familiar a m5piliation ub and lieve the information is true,accurate,and complete. <br /> "IGNAT F O PE OR DESI ATED REPRESENTATIVE DATE 134, 1 NAME OF DOCUMENT PREPARER 135_ <br /> Ilk 11/2/2007Patricia Jones <br /> NAM R( ' t) <br /> 136. TITLE OF SIGNER UL <br /> Scot D. Sandefur Director -Environmental Health & Safety <br /> *See Instructions on next page. <br /> [JN-020UPC0UPCF-5/I5 www.unidacs.org Rev.0724/06 <br />