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RECEIVE® <br />UNIFIED PROGRAM CONSOLIDATED FORM <br />FACILITY INFORMATION <br />BUSINESS OWNER/OPERATOR IDENTIFICATION SAN JOAQUIN i <br />05/05/2009 - 08:45:43 AM OFFICE OF Ell RGEN <br />Page of <br />I. IDENTIFICATION <br />FACILITY ID# 13774 1 1 BEGINNING <br />DATE N/A 100 1 <br />ENDING DATE N/A 101 <br />BUSINESS NAME (Same as FACILITY NAME or DBA - Doing Business As) 3 <br />BUSINESS PHONE 102 <br />AT&T MOBILITY-HWY 4 & S WAVERLY RD <br />800-638-2822 *2 <br />BUSINESS SITE ADDRESS 103 <br />BUSINESS FAX 102a <br />7603 S JACK TONE RD <br />Not Collected <br />BUSINESS SITE CITY104 <br />ZIP CODE 105 <br />COUNTY 108 <br />STOCKTON <br />CA <br />95215 <br />SAN JOAQUIN <br />DUN & BRADSTREET 106 <br />PRIMARY SIC 107 <br />PRIMARY NAICS 107a <br />10-202-6754 <br />4812 <br />Not Collected <br />BUSINESS MAILING ADDRESS 108a <br />4430 ROSEWOOD DR <br />BUSINESS MAILING CITY 108t <br />STATE 108c <br />ZIP CODE 108d <br />PLEASANTON <br />CA <br />94588 <br />BUSINESS OPERATOR NAME 109 <br />BUSINESS OPERATOR PHONE 110 <br />AT&T MOBILITY <br />510-305-2553 <br />Il. BUSINESS OWNER <br />OWNER NAME (14) 111 OWNER PHONE (15) 112 <br />CINGULAR & NEW CINGULAR DBA 510-305-2553 <br />1 <br />A m o_m ♦,inni7 rmv <br />113 <br />OWNER MAILING ADDRESS <br />4430 ROSEWOOD DRIVE, BLDG.3, 6TH FLR. <br />OWNER MAILING CITY 1141 <br />STATE 115 <br />ZIP CODE 11 <br />PLEASANTON <br />CA <br />94588 <br />III. ENVIRONMENTAL CONTACT <br />CONTACT NAME 117 <br />CONTACT PHONE 118 <br />EH&S - ANDREW TAYLOR <br />1 925-823-6161 <br />CONTACT MAILING ADDRESS 119 <br />CONTACT EMAIL 119a <br />2600 CAMINO RAMON RM - <br />�r.Ah <br />stephen.lockert@stantec.com <br />CONTACT MAILING CITY 120 <br />STATE 121 <br />ZIP CODE 122 <br />SAN RAMON <br />CA <br />94583 <br />IV. EMERGENCY CONTACTS <br />NAME ELLEN MAGNIE 123 NAME <br />ROBERT GARZA 128 <br />TITLE l24 TITLE <br />COMPLIANCE MANAGER <br />129 <br />OPERATIONS MANAGER <br />BUSINESS PHONE 510-305-2553 125 BUSINESS <br />PHONE 925468-8499 130 <br />24-HOUR PHONE 800-638-2822 *2 126 24-HOUR <br />PHONE 866-435-7347 131 <br />PAGER # 510-305-2553 127 PAGER <br /># 415-999-2672 132 <br />ADDITIONAL LOCALLY COLLECTED INFORMATION: 133 <br />COMPLETE PAGE 2 OF BUSINESS OWNER/OPERATOR IDENTIFICATION <br />Certification: Based on my inquiry of those individuals responsible for obtaining the information, I certify under penalty of law by signing below or certifying by the <br />established processes on the Administerting Agency's HMMP Compliance Website that I have personally examined and am familiar with the informaiton submitted and <br />believe the information is true, accurate, and complete. <br />SIGNATURE OF OWNER/OPERAT540Rj;DEASITED UPRESENTATIVE <br />DATE 1� tR 1 E OF UCMENTREPARE 1� 135 <br />NAME OF SIGNER t; VE SKANDERSON 136 <br />SKANDERSON <br />ITLEOFSIGNER 137 <br />VV <br />-u t" <br />UPCF (Rev. 12/2UU7) <br />)UNTY <br />Y SERVICES <br />