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• <br />RE7CE <br />UNIDOCS <br />FACILITY INFORMATION JAN 2 20 <br />BUSINESS OWNER/OPERATOR IDENTIFICATION PAGE - <br />Page OFEMEI•�gE <br />1. IDENTIFICATION <br />FACILITY ID # <br />1 <br />BEGINNING DATE 1W <br />ENDING DATE 101. <br />(Agency Use Only) <br />— <br />HH1 <br />III <br />BUSINESS NAME (Same as Facility Name or DBA -Doi Business As) 3. <br />BUSINESS PHONE 102. <br />T—MOBILE WEST CORPORATION SITE ID#SC07853A <br />UNMANNED FACILITY <br />BUSINESS SITE ADDRESS 103. <br />BUSINESS FAX 1028• <br />1515 SOUTH FRESNO AVE. <br />UNMANNED FACILITY <br />BUSINESS SITE CITY <br />105. <br />ZIP COD45 <br />COUNTY los. <br />STOCKTON <br />CA <br />2 0 6 <br />SAN JOAQUIN <br />DUN & BRADSTREET 06-632-8376 1 D6. <br />PRIMARY SIC 107. <br />PRIMARY NA ILS 1078. <br />4812 <br />517212 <br />BUSINESS MAILING ADDRESS lox.. <br />1755 CREEKSIDE OAKS, SUITE 190 <br />BUSINESS MAILING CITY 108b. <br />STATE 108c. <br />ZIPCODE lord <br />SACRAMENTO <br />CA <br />95833 <br />BUSINESS OPERATOR NAME 109. <br />BUSINESS OPERATOR PHONE 11U <br />T—MOBILE WEST CORPORATION <br />(425)383-4000 <br />II. BUSINESS OWNER <br />OwNERNAME T—MOBILE WEST CORPORATION 11' <br />OWNER PHONE ' <br />(425)383-4000 <br />OWNER MAILING ADDRESS 12920 SE 38TH STREET <br />OWNER MAILING CITY 114. <br />STATE 115. <br />ZIP CODE a, <br />BELLEVUE <br />WA <br />1 <br />98006 <br />III. ENVIRONMENTAL CONTACT <br />CONTACT NAME 117, <br />CONTACT PIIONIf <br />MICHELLE STEFFLER <br />(916)643-8979 <br />CONTACT MAILING ADDRESS 112 <br />CONTACT EMAIL <br />1755 CREEKSIDE OAKS, SUITE 190 <br />120. <br />CONTACT MAILING CITY SACRAMENTO <br />STATE 121. <br />CA <br />ZIP CODE 122 <br />95833 <br />-PRIMARY- IV. EMERGENCY <br />CONTACTS -SECONDARY- <br />NAME 123. <br />NAME <br />NICHOLAS H. FISCHER <br />T—MOBILE WEST NOCC <br />TITLE 124. <br />TITLE <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)662-4662 <br />(888)662-4662 <br />PAGER# N/A 127• <br />PAGER # 132. <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 />Certification: a o my inquiry of tho in ividuals responsible for obtaining the information, I certify under penalty of law that I have personally examined and <br />am familiar with e i oo ation submitted d lieve the information is true, accurate, and complete. <br />PE T R O ESIGATNSENTATIVE <br />SIGNATURE OFJ(p <br />DATE 134. <br />NAME OF DOCUMENT PREPARER 135. <br />12/16/2011 <br />KELLY MICHAELS OF EAS <br />NAME OF SIGNE136. <br />TITLE OF SIGNER 137. <br />NICHOLFISCHER <br />MANAGER— ENGINEERING <br />UN -020 1 J www.unidocs.org 5/17 - Rev. 12/14/10 <br />ry <br />RV1CS3 <br />