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Statement of Exemption <br />AN 12 2012 <br />OFFICE OF EOgQUIN C0UN1y <br />Statement of Exemption: to be completed only if you do NOT have to prepare a plan. Verify MERGENCYSMVICE-8 <br />exemption with the CUPA or Administering Agency (AA). <br />Business Name: T -MOBILE WEST CORPORATION (SITE ID# SC07014A ) <br />Business Address: 1610 ISHI GOTO STREET <br />City STOCKTON Zip Code 95206 <br />Business Telephone: ( ) UNMANNED FACILITY <br />I understand the requirements for submitting a Hazardous Materials Business Emergency <br />Plan. I declare, under penalty for perjury, that a Hazardous Materials Business Emergency <br />Plan is not requ%ed for this business. <br />Business Owner/Opat r Name: T -MOBILE WEST CORPORATION <br />Signature: Date: <br />Title of Signer: MANAG —ENGINEERING <br />12/16/2011 <br />Emergency Telephone of Owner/Operator (24-hour contact): (888) 662-4662 <br />Reason you believe your business is exempt: <br />This unmanned cell site location is exempt from the hazardous materials business plan requirements, as <br />specified in the California Health & Safety Code, Chapter 6.95, Section 25503.5 (b) and/or (c), for the <br />following reasons: <br />It does not handle a hazardous material, waste, or a mixture containing a hazardous material, in total <br />quantities equal to or greater than: <br />• 500 pounds of solids <br />• 55 gallons of liquids <br />• 200 cubic feet of compressed gasses at standard temperature and pressure <br />• Quantities of radioactive materials for which an emergency plan is required pursuant to <br />Parts 30, 40 or 70 of Chapter 10, Title 10, Code <br />Should a modification to this location be conducted in the future that would raise the levels above the <br />required reporting thresholds listed above a full HMBP and BEP will be submitted to county CUPA, AA, <br />PA, FD or DENS. <br />T -MOBILE West Corporation, 1.855 Gateway Blvd., 1001 Floor, Concord, CA 94520 <br />