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JAN LL2112 <br />UNIDOCSFACILITY <br />5AN J <br />�FFIc�GFEMcaG <br />BUSINESS OWNER/OPERATOR IDENTIFICATION PAGE NC <br />Page of <br />I. IDENTIFICATION <br />FACILITY ID # <br />BEGINNING DATE 100- <br />ENDING DATE. 101 <br />(Agency Use Only) <br />BUSINESS NAME (Same as Facility Name or DBA —Doing Business As) 3. <br />BUSINESS PHONE 102. <br />T—MOBILE WEST CORPORATION SITE ID#SC07220A <br />UNMANNED FACILITY <br />BUSINESS SITE ADDRESS 103• <br />BUSINESS FAX 102., <br />6844 E FAIRCHILD ROAD <br />UNMANNED FACILITY <br />BUSINESS SITE CITY 104 <br />ZIP CODE 105• <br />COUNTY 108. <br />STOCKTON <br />CA <br />95215 <br />SAN JOAQUIN <br />DUN & BRADSTREET 106, <br />06-632-8376 <br />PRIMARY SIC 107 <br />PRIMARY NAICS 107x. <br />4812 <br />517212 <br />BUSINESS MAILING ADDRESS IOU. <br />1755 CREEKSIDE OAKS, SUITE 190 <br />BUSINESS MAILING CITY 1086. <br />STATE 108c. <br />ZIP CODE 108d. <br />SACRAMENTO <br />CA <br />I <br />95833 <br />BUSINESS OPERATOR NAME 109. <br />BUSINESS OPERATOR PHONE 10 <br />T—MOBILE WEST CORPORATION <br />425 383-4000 <br />II. BUSINESS OWNER <br />OWNERNA%11 T -MOBILE WEST CORPORATION Ill' <br />OWNER PHONE 112, <br />(425)383-4000 <br />OWNER MAILING ADDRESS 113. <br />12920 SE 38TH STREET <br />OWNER MAILING CITY 114- <br />STATE 115. <br />ZIP CODE <br />BELLEViTE <br />WA <br />98006 <br />III. ENVIRONMENTAL CONTACT <br />CONTACT NAME <br />CONTACT PHONE <br />MICHELLE STEFFLER <br />916)643-8979 <br />CONTACT MAILING ADDRESS 119. <br />CONTACT EMAIL <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 123. <br />NAME 128. <br />NICHOLAS H. FISCHER <br />T—MOBILE WEST NOCC <br />TITLE Iza. <br />TITLE 129. <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)662-4662127. <br />662-4662 <br />PAGER # N/A 127. <br />PAGER # I32. <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 />Certi 1 tion: Hed on my inquiry those individuals responsible for obtaining the information, I certify under penalty of law that 1 have personally examined and <br />am famiAwil t e information s mi ed and believe the information is true, accurate, and complete. <br />SIGNATURE WN OPE R OR DESIGNATED REPRESENTATIVE <br />DATE 134. <br />NAME OF DOCUMENT PREPARER 135. <br />12/16/2011 <br />IKELLY MICHAELS OF EAS <br />NAME OF SIG (print) 136. <br />TITLE OF SIGNER 137. <br />NICHOtAS H. FISCHER <br />MANAGER— ENGINEERING <br />UN -020 `% www.unidocs.org 5/17 - Rev. 12/14/10 <br />INTY <br />3--RV/GL-3 <br />