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UNIDOCS Z 2012 <br />FACILITY INFORMATION <br />BUSINESS OWNER/OPERATOR IDENTIFICATION PAGED 4Q11/VCp <br />Page of?�Rv/�' <br />1. IDENTIFICATION <br />FACILITY ID # <br />BEGINNING DATE lOQ <br />ENDING DATE 101. <br />(Agency Use Only) <br />— <br />1 <br />BUSINESS NAME (Same as Facility Name or DBA – Doing Business As) 3• <br />BUSINESS PHONE 102. <br />T—MOBILE WEST CORPORATION SITE ID#SC13100A <br />UNMANNED FACILITY <br />BUSINESS SITE ADDRESS 3550 SOUTH MANTHEY ROAD 103• <br />BUSINESS FAX 102x. <br />UNMANNED FACILITY <br />BUSINESS SITE CITY 104. <br />ZIP COD5206 105. <br />COUNTY 108. <br />STOCKTON <br />CA <br />SAN JOAQUIN <br />DUN & BRADSTREET PRIMARY SIC 107. <br />06-632-8376 <br />PRIMARY NAICS 107x. <br />4812 <br />517212 <br />BUSINESS MAILING ADDRESS 108a, <br />1755 CREEKSIDE OAKS, SUITE 190 <br />BUSINESS MAILING CITY 1086. <br />STATE 10k <br />ZIP CODE toad. <br />SACRAMENTO <br />CA <br />I <br />95833 <br />BUSINESS OPERATOR NAME 109 <br />BUSINESS OPERATOR PHONE 11° <br />T—MOBILE WEST CORPORATION <br />425 383-4000 <br />1I. BUSINESS OWNER <br />OWNERNAME T—MOBILE WEST CORPORATION 111. <br />OWNER PHONE <br />(425)383-4000 <br />OWNER MAILING ADDRESS <br />12920 SE 38TH STREET <br />OWNER MAILING CITY 114, <br />STATE M. <br />ZIP CODE <br />BELLEVUE <br />WA <br />1 I <br />98006 <br />III. ENVIRONMENTAL CONTACT <br />CONTACT NAME 117. <br />CONTACT PHONE 1 Is, <br />MICHELLE STEFFLER <br />(916)643-8979 <br />CONTACT MAILING ADDRESS 119. <br />CONTACT EMAIL 114x. <br />1755 CREEKSIDE OAKS, SUITE 190 <br />CONTACT MAILING CITY SACRAMENTO120• <br />. <br />STATE CA 121. <br />ZIP CODE 95833 122. <br />-PRIMARY- IV. EMERGENCY <br />CONTACTS -SECONDARY- <br />NAME 123. <br />NAME 128. <br />NICHOLAS H. FISCHER <br />T—MOBILE WEST NOCC <br />TITLE 124. <br />TITLE 179• <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 />Certifieatio Base on my i quiry of those individuals responsible for obtaining the information, I certify under penalty of law that I have personally examined and <br />am familiarwi the i fonnati n submittedind believe the information is true, accurate, and complete. <br />SIGNATURE OF ER/O RATO <br />DESIGNA RESENTATIVE <br />DATE 134. <br />NAME OF DOCUMENT PREPARER 133. <br />12/16/2011 <br />KELLY MICHAELS OF EAS <br />NAME OF SIGNER n t) 136. <br />TITLE OF SIGNER <br />NICHOLA . FISCHER <br />MANAGER— ENGINEERING <br />UN -020 U www.unidocs.org 5/17 - Rev. 12/14/10 <br />