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ti <br />BUSINESS OWNER/OPERATOR IDENTIFICATION FORM <br />6/19/2008 11 1 <br />Account #: 12789 <br />I. IDENTIFICATION <br />BUSINESS NAME (4) AT&T MOBILITY-ELMWOOD BUSINESS PHONE (5) 1800-832-6662 *2 <br />SITE ADDRESS (6) <br />13255 1�FA�RCH LN <br />Street No. Direction Street Name Street Type A t/Bld,11/Suite <br />CITY (7) ISTOCKTON STATE (8) C A ZIP (9) 95212 <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 1 1 916-285-4201 <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) SACRAMENTO STATE (18) CA ZIP (19) 95834 <br />CONTACT NAME (20) 1EH&S - JESSICA NIELSEN <br />MAILING ADDRESS (22) <br />(If different from site address) 3851 N FREEWAY BLVD —11 <br />AL CONTACT <br />CONTACT PHONE (21) 1916-285-4201 <br />Street No. lltrechon Street Name Street I e A t/I31d /Suite <br />CITY (23) SACRAMENTO STATE (24) F:1 <br />ZIP (25) 95834 <br />Primary IV. EMERGENCY CONTACTS Secondary <br />NAME (26) ELLEN MAGNIE NAME (3 1) FHIZAL ABAWI <br />TITLE (27) COMPLIANCE MANAGER TITLE (32) COMPLIANCE ANALYST II <br />BUSINESS PHONE (28)1510-305-2553 <br />24-HOUR PHONE (29) 1800-832-6662 *2 <br />PAGER # (30) 1510-305-2553 <br />BUSINESS PHONE (33) <br />24-HOUR PHONE (34) 1800-832-6662 *2 <br />PAGER # (35) <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) ISTANTEC CONSULTING INC. <br />NAME OF OWNER/OPERATOR (39) NEW CINGULAR WIRELESS DATE (40) <br />PCS, LLC DBA AT&T <br />