Laserfiche WebLink
UNIDOCS <br />FACILITY INFORMATION SAN <br />BUSINESS OWNER/OPERATOR IDENTIFICATION PAGE 12 zOj <br />I. IDENTIFICATION SyS - <br />FACILITY ID # <br />BEGINNING DATE 100. <br />ENDING DATE 101 <br />(Agency Use Only) <br />BUSINESS NAME (Same as Facility Name or DBA - Doing Business As) 3. <br />BUSINESS PHONE 102• <br />T—MOBILE WEST CORPORATION SITE ID#SC13367B <br />UNMANNED FACILITY <br />BUSINESS SITE ADDRESS 103' <br />647 WEST LINDSAY STREET <br />BUSINESS FAX 1028. <br />UNMANNED FACILITY <br />BUSINESS SITE CITY 104. <br />STOCKTON <br />ZIP COD 5203 los. <br />COUNTY 108. <br />CA <br />SAN JOAQUIN <br />DUN & BRADSTREET 1116. <br />06-632-8376 <br />PRIMARY SIC 107• <br />PRIMARY NAIC'S 107x. <br />4812 <br />517212 <br />BUSINESS MAILING ADDRESS 108a, <br />1755 CREEKSIDE OAKS, SUITE 190 <br />BUSINESS MAILING CITY lusb. <br />STATE 108c. <br />ZIPCODE�: 108d. <br />SACRAMENTO <br />CA <br />95833 <br />BUSINESS OPERATOR NAME 109• <br />BUSINESS OPERATOR PHONE 110. <br />T—MOBILE WEST CORPORATION <br />(425)383-4000 <br />IL BUSINESS OWNER <br />OWNER NAME T—MOBILE WEST CORPORATION <br />OWNER PHONE 111. <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 11s. <br />MICHELLE STEFFLER <br />(916)643-8979 <br />_ <br />CONTACT MAILING ADDRESS 119. <br />CONTACT EMAIL 1 19a <br />1755 CREEKSIDE OAKS, SUITE 190 <br />CONTACT MAILING CITY <br />SACRAMENTO <br />STATE 121. <br />CA <br />ZIP CODE 1-" <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.TITLE <br />129. <br />MANAGER— ENGINEERING <br />N/A <br />BUSINESS PHONE 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 />127• <br />PAGER # N/A <br />PAGER # 132• <br />N/A <br />ADDITIONAL LOCALLY COLLECTED INFORMATION: 13',. <br />Billing Address: 1755 CREEKSIDE OAKS, SUITE 190 SACRAMENTO„ CA 95833 <br />Property Owner: Phone No.: ( ) <br />Certification: seiny nquiry of individuals responsible for obtaining the information, 1 certify under penalty of law that I have personally examined and <br />am familiar with th on submitt d d believe the information is true, accurate, and complete. <br />SIGNATURE OF OPE TO DESIGN PRESENTATIVE <br />DATE 134. <br />NAME OF DOCUMENT PREPARER <br />12/16/2011 <br />KELLY MICHAELS OF EAS <br />NAME OF SIGNER 136• <br />TITLE OF SIGNERNICHOLAFISCHER <br />MANAGER— ENGINEERING <br />UN -020 I/ wsssv.unidocs.org 5/17 -Rev. 12/14/10 <br />083 <br />