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UNIDOCS <br />FACILITY INFORMATION SAN 12 <br />201 <br />BUSINESS OWNER/OPERATOR IDENTIFICATION PAC,SqN <br />Page UtEMFR-€N <br />I. IDENTIFICATION <br />FACILITY ID # <br />1- <br />BEGINNING DATE 100. <br />ENDING DATE 101. <br />(Agency Use Only) <br />11-1 <br />1-1111 <br />BUSINESS NAME (Same as Facility Name or DBA Doing Business As) 3. <br />BUSINESS PHONE 10'- <br />T—MOBILE WEST CORPORATION SITE ID#SC07254A <br />UNMANNED FACILITY <br />BUSINESS SITE ADDRESS 103• <br />5388 EAST SECTION AVE. <br />BUSINESS FAX 102a. <br />UNMANNED FACILITY <br />BUSINESS SITE CITY 104 <br />ZIP CO 105' <br />COUNTY ION, <br />STOCKTON <br />CA <br />95215 <br />SAN JOAQUIN <br />DUN & BRADSTREET 106. <br />06-632-8376 <br />PRIMARY SIC 107 <br />PRIMARY NAICS 107u. <br />4812 <br />517212 <br />BUSINESS MAILING ADDRESS 10x.. <br />1755 CREEKSIDE OAKS, SUITE 190 <br />BUSINESS MAILING CITY 108b. <br />STATE 108c <br />ZIP CODE load. <br />SACRAMENTO <br />CA <br />95833 <br />BUSINESS OPERATOR NAME 109. <br />BUSINESS OPERATOR PHONE <br />T—MOBILE WEST CORPORATION <br />425 383-4000 <br />II. BUSINESS OWNER <br />OWNERNAME T—MOBILE WEST CORPORATION 111' <br />OWNER PHONE, 112, <br />425) 383-4000 <br />OWNER MAILING ADDRESS 113. <br />12920 SE 38TH STREET <br />OWNER MAILING CITY 114, <br />STATE 115. <br />ZIP CODE 116 <br />BELLEVUE <br />WA <br />98006 <br />III. ENVIRONMENTAL CONTACT <br />CONTACT NAME 117. <br />CONTACT PHONE IIs, <br />MICHELLE STEFFLER <br />(916)643-8979 <br />CONTACT MAILING ADDRESS 119. <br />CONTACT EMAIL 119.. <br />1755 CREEKSIDE OAKS, SUITE 190 <br />CONTACT MAILING CITY SACRAMENTO 120. <br />1 STATE CA 121. <br />ZIP CODE " <br />95833 <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 110 <br />MANAGER— ENGINEERING <br />N/A <br />BUSINESS PHON1: 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 />Certificatt : B d on my inquiry of those individuals responsible for obtaining the information, I certify under penalty of law that I have personally examined and <br />am familiar 'th th information sub ed and believe the information is true, accurate, and complete. <br />SIGNATURE ER/ PE REPRESENTATIVE <br />DATE 134. <br />NAME OF DOCUMENT PREPARER 135. <br />7!7�� <br />12/16/2011 <br />KELLY MICHAELS OF EAS <br />NAME OF SIGNE (print) 136. <br />TITLE OF SIGNER 137. <br />NICHOL H. FISCHER <br />MANAGER— ENGINEERING <br />UN -020 U www.unidocs.org 5/17 - Rev. 12/14/10 <br />y <br />VICES <br />