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UNIFIED PROGRAM CONSOLIDATED FORM <br /> FACILITY INFORMATION <br /> BUSINESS OWNER/OPERATOR IDENTIFICATION <br /> Pae 2 of 10 <br /> I. IDENTIFICATION <br /> FACILITY ID# L BEGINNING DATE IN ENDING DATE 101- <br /> (Agency Use Only) 1/2 1/20/2010 <br /> BUSINESS NAME(s.n FACILITY NAA¢) 3. BUSINESS PHONE 102- <br /> S rint Nextel Cell Site SF03UB073 877 347 4457 Option 6 <br /> BUSINESS SITE ADDRESS Ia3_ <br /> 9629 N. Highway 99 <br /> CITY IN ZIP CODE los. <br /> Stockton CA 95212 <br /> DUN&BRADSTREET 106. NAICS CODE Im. <br /> 00-694-2395 517212 <br /> COUNTY Jos, <br /> San Joaquin <br /> BUSINESS OPERATOR NAME 109- BUSINESS OPERATOR PHONE 110. <br /> S rint Nextel Corporation 877 347 4457 ext. 6 <br /> II. BUSINESS OWNER <br /> OWNER NAME III. OWNER PHONE 112. <br /> Sprint Nextel Corporation 877 347 4457 ext. 6 <br /> OWNER MAILING ADDRESS 113. <br /> 6480 Sprint Parkway, KSOPHM0516-58872 <br /> CITY 114- STATE 115_ ZIP CODE 116. <br /> Overland Park I KS 66251 <br /> III. ENVIRONMENTAL CONTACT <br /> CONTACT NAME 117. CONTACT PHONE ns. <br /> California EHS S ecialist 913 315-8624 ext. <br /> CONTACT MAILING ADDRESS 119. <br /> 6480 Sprint Parkway, KSOPHM0516-5B872 <br /> CITY 120, STATE 121, ZIP CODE 122. <br /> Overland Park I KS 66251 <br /> -PRIMARY- IV. EMERGENCY CONTACTS -SECONDARY- <br /> NAME 123. NAME 128, <br /> Environmental Surveillance Team Environmental Health & Safety Help Line <br /> TITLE 124. TITLE 129_ <br /> Network En ineer Environmental Health & Safety HelD Line <br /> BUSINESS PHONE 125. BUSINESS PHONE 130_ <br /> 866 400 6040 ext. 2 1 1.1 877 347 4457 <br /> 24-HOUR PHONE- 126, 24-HOUR PHONE- 131. <br /> 866 400 6040 ext. 2 1 1.1 877 347 4457 <br /> PAGER# 127. PAGER# 132. <br /> n/a n/a <br /> ADDITIONAL LOCALLY COLLECTED INFORMATION: 133. <br /> Billing Address: 6480 Sprint Parkway, KSOPHM0516-5B872, Overland Park, KS 66251 <br /> Certification: Based on my inquiry of those individuals responsible for obtaining the information,1 certify under penalty of law that I have personally examined and <br /> am familiar with the infomunion submitted and believe the information is true,accurate,and complete. <br /> SIGNATURE OF OWNER/OPERATOR OR DESIGNATED REPRESENTATIVE DATE 134. NAME OF DOCUMENT PREPARER 135. <br /> 1/20/2007 Sarah Vogel <br /> NAW OF SIGNER(pnno ub. TITLE OF SIGNER 137 <br /> Sarah Vogel as acient for S rin Nextel Staff Scientist <br /> See Instructions on next page. <br /> UN-020UPCF-2/11 www.unidoes.org Rev.07/24/06 <br />