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BUSINESS OWNER/OPERATOR IDENTIFICATION FORM <br />6/18/2005 11 ACCOL111t #: 12786 <br />I. IDENTIFICATION <br />BUSINESS NAME (4) AT&T MOBILITY -LINCOLN BUSINESS PHONE (5) VILLAGE 1800-832-6662 *2 <br />SITE ADDRESS (6) 18177 ❑ RINDGE TRACT RD <br />Street No. Direction Street Name Street T e A t/Bldg=/SUIIC <br />CITY (7) ISTOCKTON STATE (8) CA ZIP (9) F95219 <br />DUN & (10) 10-202-6754 SIC CODE (4 DIGIT #) (11) 4812 <br />BRADSTREET <br />OPERATOR (12) AT&T MOBILITY OPERATOR PHONE (13) <br />NAME 916-285-4201 <br />II. BUSINESS OWNER <br />OWNER NAME (14) CINGULAR & NEW CINGULAR I OWNER PHONE (15) 916-285-4201 <br />DBA AT&T MOBILITY <br />OWNER MAILING ADDRESS (16) 13851 N. FREEWAY BLVD. <br />(If different from site address) <br />CITY (17) 1SCARAMENTO <br />STATE (18) CI AI ZIP (19) <br />III. ENVIRONMENT <br />CONTACT NAME (20) IEH&S - JESSICA NIELSEN <br />MAILING ADDRESS (22) <br />(If different from site address) 3851 7N FREEWAY ��BLVD <br />tL CONTACT <br />CONTACT PHONE (2 1) 1916-285-4201 <br />Street No. Direction Street Name Street Type Apt/Bldg/Suite <br />CITY (23) STATE (24) ZIP (25) <br />SACRAMENTO CA 195834 <br />piimau� IV. EMERGENCY CONTACTS Secondary <br />NAME (26) <br />ELLEN NIAGNIE <br />TITLE (27) <br />COMPLIANCE MANAGER <br />BUSINESS PHONE (28) 1510-305-2553 <br />24-HOUR PHONE (29) 500-832-6662 *2 <br />PAGER # (30) 510-305-2553 <br />NAME (3 1) <br />TITLE (32) <br />HIZAL ABAWI <br />OMPLIANCE ANALYST H <br />BUSINESS PHONE (33) <br />24-HOUR PHONE (34) <br />-468-8553 <br />PAGER # (35) 1925-286-3207 <br />*2 <br />EXTREMELY HAZARDOUS SUBSTANCES (EHS) <br />ON-SITE EHS (36) YES If yes, and above Threshold Planning Quantities, attach a sheet of paper with a general <br />description of the process and principle equipment involved with the EHS. <br />ADDITIONAL LOCALLY COLLECTED INFORMATION (37) Provide information requested on the 2nd page of this form <br />NAME OF DOCUMENT PREPARER (38) <br />STANTEC CONSULTING INC. <br />NAME OF OWNER/OPERATOR (39) NEW CINGULAR WIRELESS DATE (40) <br />PCS, LLC DBA AT&T <br />