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RECE1W® <br />APR 18 2011 <br />UtNINEV FRUGRA I CONSOLIDATED FORMFACILITY QUIN <br />I 0CEo�EMER�EN <br />BUSINESS OWNER/OPERATOR oly <br />RE <br />IDENTIFICATIONION <br />RVI <br />(1/7/2011 -02:49:56 PM) <br />Page of <br />L IDENTIFICATION <br />FACILITY IDt 13774 <br />1 BEGINNING DATE N/A ENDING DATE 1 <br />BUSINESS NAME (Same as FACILCI'Y NAME or DDA <br />N/A <br />- Doing Business As) 3 BUSINESS PHONE <br />,AT. MOBILITY -H WY 4 & S WAVERLY RD <br />102 <br />800.638-2822 +2 <br />B ITER <br />7603 S JACK TONE RD <br />BUSINESS FAX 1 a <br />Not Collected <br />BUSINESS SITE CITY <br />STOCKTON <br />104 ZIP CODE 105 COUNTY 108 <br />CA 95215 SARI JOAQUIN <br />DUN REIiT <br />106 PRIMARY SIC 107 PRIMARY NAILS 107a <br />10-202-6754 <br />4812 Not Collected <br />BUSINESS MAILING ADDRISS <br />P.O. BOX 5095 <br />RM 3E000 IOBa <br />BUSINESS MAILING CITY <br />1084 STATE 108cZIP CODE 108d <br />SAN RAMON <br />CA 94583 <br />BUSINESS , OPE NAME <br />SINES 110 <br />AT&T MOBILITY <br />11. BUSINESS OWNER <br />OWNER NAME (14) <br />CINGULAR & NEW CINGULAR DBA <br />III <br />OWNER PHONE (15) 1 l2 <br />. •v o -m unora 1•r11, <br />9WNER-5415 <br />OWNER MAILING ADDRESS <br />P.O. BOX 5095, RM 3E000 <br />113 <br />OWNER MAILING CITY --114 <br />STAT 11 P CODE 116 <br />SAN RAMON <br />CA 94583 <br />III. ENVIRONMENTAL CONTACT <br />CONTACT NAME <br />117 1 <br />CONTACT PHONE <br />EII&S - SIIEILA CABALLERO <br />118 <br />925-901.5415 <br />CONTACT MAILING ADDRESS <br />NTACT EMAIL <br />P.O. BOX 5095 <br />RMeve.skanderson@stantee.com <br />119a <br />C t MAILI TTY <br />�»nnn <br />+12 <br />ZIPCOD 122 <br />SANRAMON <br />7� <br />A 94583 <br />IV. EMERGENCY CONTAC"I'S <br />NAME <br />SHEILA CABALLERO <br />123 NAME NETWORK WIREI,F.SS CONTROL 128 <br />TITLE(:FNTFR <br />MANAGER EII&S <br />124 TITLE 129 <br />CALL CENTER <br />BUSINESS PH925-901.5415 <br />M BUSINESS PH N , 130 <br />800-638-2822 <br />24-HOUR PHONE 800-638-2822 +2 <br />126 24-HOl1R PHONE 131 <br />800-566-9347 <br />PAGIiWCE1.Lt N/A <br />127 <br />PAGEWCELL# 132 <br />N/A <br />ADDITIONAL LOCALLY COLLECTED INFORMATION: <br />133 <br />COMPLF`TE PAGE 2 OF BUSINESS OWNFR/OPERATOR IDENTIFICATION <br />Certification: Bascd on my inquiry of (hose individuals responsible for obtaining the information,/ certify under Penalty of law by signing below or certifying by the <br />established proccssa on the AJu inistuting Ageucyb 1IMMP Compliance %yebsite that I have Personally examined and am familiar <br />beliore the inforrnation is True, accurate, and can tete. <br />with the infonnaiton submitted and <br />SIU E U}' UPFRA' O Z DESIGN <br />SENT TI I: NAME F D (. MENT , t - 12ER I. <br />=,34 <br />. TEVE SKANDEARop. <br />NAME OF SIGNISR (punt) <br />136 I'[TI-E OF SIUNFR <br />137 <br />4"Oc(4 k <br />I1PCF(Rev 190n1`171 <br />,Es <br />