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uormar�uaa u�:ca zu�norua3u uvvJrcurvrw=l <br /> UNIFIED PROGRAM CONSOLIDATED FORM <br /> FACILITY INFORMATION p <br /> BUSINESS OWNER/OPERATOR IDENTIFICATION AUG 2 4 2REC Ll <br /> — AL <br /> I.IDENTIFICATION PERMRI:EB <br /> FACILITY IDa �,�.,; 1 BEGINNING DATE III <br /> ' BUSINESS PHON6GD CE <br /> � QFEMERGEN Y�RVICES <br /> BUSM}SS AME(s'•rer FAcrtlrr nAsc,.oeA-A,�q1 Ru.00.wq J <br /> Q.wast Cwnmunicatiom Company,LLC dba Centurylink QCC- Stockton 206-346-7532 <br /> BUSINESS STM ADDRESS <br /> 103 BUSINESS FAX a <br /> 52 East Li dsa <br /> •BUSIN SSsITECiTY20 - 45-20 <br /> CA ZIPCODE I s C Inr <br /> 0.0 <br /> DlIN @BRA DSTREEI 11 - <br /> °e PRIMARY SIC itn PRIMARY NAICS loft <br /> BUSINESS MAILIL AD <br /> 4-872- A 4813 51 0 <br /> DRESS <br /> 1 7' u 712 <br /> BUSINESS MAILINGCTTY <br /> �a^ <br /> ttle STATE IMO ZIP CODE � <br /> ca <br /> BUSINESS OPERATOR NAME WA 981 <br /> BITSINESS OPERATOR PHON6 IIe <br /> U.PUSINEW OWNER <br /> OWN6R NAME lit OWNER PHONE <br /> na <br /> west C unioati s L <br /> MAILING ADDRESS (a Delaware Com 206-34 -75 <br /> OWNER <br /> 1 Cent12 <br /> e 113 <br /> OWNER MAILING CITY 11• STATE IU Zu'l Its <br /> M <br /> 71203 <br /> III-ENVE11IONMENTAL CONTACT <br /> CONTACT NAME 119 CONIACTPHONE ne <br /> tt -346- 532 <br /> CONTACT MAILING ADDRESS ns ciml 7EMAIL Iis. <br /> 16 7°'Ave ue RoornY12 a°+esR.r4ia-°•N es.� <br /> CONTACT MAILING CfrY uo STATE ZIPCODE Izt <br /> Seattle A 98 1 <br /> NAME <br /> -PRIMARY- IV.EMERGENCY CONTACTS -SECONDARY- <br /> TITLE <br /> is NAME In Juli avides <br /> 1z4 TIiTF <br /> 24- our EMq9e—ncY Operator area ar>a er so <br /> BUSINESS PHONE laJ BUSINE59 PHONE <br /> 66-864-2 5 6 631 2 >o <br /> 24.HOUR PHONE las 1A-HOUR PNONE <br /> lit <br /> PAOERAGERM -2255 1620 5 31 <br /> In PAOFR• <br /> 866- -2255 'Ja <br /> ADDITIONAL LOCALLY COLLECT®INFDRMATION: <br /> nJ <br /> CetiRurion: Bud o°my YYPIiry <br /> III I, ildivkill RII Ietpaleible Att ohMmttg the infoteoeetlq 1 esti[]'I1e1dc Awl of 1Rv Ilui I W ve <br /> am Lilnlur rith the inklmetioR submited.Id heh°.c tho in61mRuoR u OIIIe,eecuntq eed emlplele. 'r Pseo�IH eMmind and <br /> SIGNATUREOF OWNF. OR DESIONATFA RFaRIVIl TN6 W'aP iw <br /> 9:1 .- NAM&OP IN 5/2011 <br /> Its <br /> nI OF SIONE ) 8/15/2 Thomas Pitts <br /> IN 11I BOF3PaWR <br /> Thomas J. Pitts Env'rMncnW HgWth and Safety <br /> 137 <br />