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UN(DOCS <br /> FACILITY INFORMATION AIV 12 2012 <br /> BUSINESS OWNER/OPERATOR IDENTIFICATION PAGE, <br /> I. IDENTIFICATION RV <br /> FACILITY[D# BEGINNING DATE tat. ENDING DATE tot. <br /> (Agency Use Only) — — <br /> BUSINESS NAME(Same as Facility Name or DBA-Doing Business As) 3. BUSINESS PHONE 102. <br /> T—MOBILE WEST CORPORATION SITE ID#SC07243A UNMANNED FACILITY <br /> BUSINESS SITE ADDRESS 103. BUSINESS FAX 1028. <br /> 1805 N CALIFORNIA STREET UNMANNED FACILITY <br /> BUSINESS SITE CITY 'o ZIP CODE 105. COUNTY 108. <br /> STOCKTON CA 95204 SAN JOAQUIN <br /> DUN&BRADSTREET G6-632-8376 1116PRIMARY SIC 107. PRIMARY NAICS 1078. <br /> 4812 517212 <br /> BUSINESS MAILING ADDRESS 10Sa. <br /> 1755 CREEKSIDE OAKS, SUITE 190 <br /> BUSINESS MAILING CITY SACRAMENTO CA 108b. STATE 108c I ZIP CODE 95833 load. <br /> BUSINESS OPERATOR NAME 109. BUSINESS OPERATOR PHONE 110 <br /> T—MOBILE WEST CORPORATION (425) 383-4000 <br /> II. BUSINESS OWNER <br /> OWNERNAME T—MOBILE WEST CORPORATION 111' OWNERPHONE <br /> (425) 383-4000 <br /> OWNER MAILING ADDRESS 113 <br /> 12920 SE 38TH STREET <br /> OWNER MAILING CITY BELLEVUE WA 114. STATE 1 1S_ ZIP CODE 98006 1 <br /> Ill. ENVIRONMENTAL CONTACT <br /> CONTACT NAME 117. CONTACT PHONE 118. <br /> MICHELLE STEFFLER (916) 643-8979 <br /> CONTACT MAILING ADDRESS 119. CONTACT EMAIL 119& <br /> 1755 CREEKSIDE OAKS, SUITE 190 <br /> CONTACT MAILING CITY SACRAMENTO CA 95833 i'0 STATE 121. ZIP CODE 122 <br /> -PRIMARY- IV. EMERGENCY CONTACTS -SECONDARY- <br /> NAME 123. NAME 128. <br /> NICHOLAS H. FISCHER T—MOBILE WEST NOCC <br /> TITLE 124. TITLE 129. <br /> MANAGER— ENGINEERING N/A <br /> BUSINESS PHONE 125. BUSINESS PHONE 130. <br /> (916) 622-0137 (888)662-4662 <br /> 24-HOUR PHONE 126. 24-HOUR PHONE 131. <br /> (888) 662-4662 (888) 662-4662 <br /> PAGER# N/A <br /> 127. 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 /> Certification: ed n my inquiry of those individuals responsible for obtaining the information,I certify wider penalty of law that I have personally examined and <br /> am familiar with th ' o ation submitted and believe the information is true,accurate,and complete. <br /> SIGNATURE OF OOPERAT OR DESIGNATED REPRESENTATIVE DATE 134. NAME OF DOCUMENT PREPARER t35. <br /> 12/16/2011 KELLY MICHAELS OF EAS <br /> NAME OF SIGNER(prin 136• TITLE OF SIGNER <br /> NICHOLAS FISCHER MANAGER— ENGINEERING <br /> UN-020 www.unidocs.org 5/17-Rev.12/14/10 <br />