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RECEIVED <br />UNIDOCS <br />FACILITY INFORMATION <br />BUSINESS OWNER/OPERATOR IDENTIFICATION PA SAN JOAQUIN COUNT <br />Page _ of <br />I. IDENTIFICATION <br />FACILITY ID # <br />1' <br />BEGINNING DATE,, 100 <br />ENDING DATE, 101. <br />(Agency U.se 0n1}9 <br />— <br />�—J <br />BUSINESS NAME (Same as Facility Name or DBA - Doing Business As) 3. <br />BUSINESS PHONE 102• <br />T—MOBILE WEST CORPORATION SITE ID#SC13368C <br />UNMANNED FACILITY <br />BUSINESS SITE ADDRESS 4233 CORONADO AVE. 103. <br />BUSINESS FAX 102x. <br />UNMANNED FACILITY <br />BUSINESS SITE CITY 104. <br />STOCKTON <br />ZIP COD 105. <br />5204 <br />COUNTY los. <br />CA <br />SAN JOAQUIN <br />DUN & BRADSTREEI 106. <br />06-632-8376 <br />PRIMARY SIC 107• <br />PRIMARY NAILS 107a. <br />4812 <br />517212' <br />BUSINESS MAILING ADDRESS lora. <br />1755 CREEKSIDE OAKS, SUITE 190 <br />BUSINESS MAILING CITY 1086• <br />STATE 108. <br />ZIP CODE lora. <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 />II. BUSINESS OWNER <br />OWNERNAME T—MOBILE WEST CORPORATION 111' <br />OWNERPHONE 112. <br />(425)383-4000 <br />OWNER MAILING ADDRESS 113 <br />12920 SE 38TH STREET <br />OWNER MAILING CITY 4 <br />STATE 115. <br />ZIP CODE 116. <br />BELLEVUE <br />WA <br />98006 <br />III. ENVIRONMENTAL CONTACT <br />CONTACT NAME 117. <br />CONTACT PHONE 118. <br />MICHELLE STEFFLER <br />(916)643-8979 <br />CONTACT MAILING ADDR I SS 119. <br />CONTACT EMAIL 119x. <br />1755 CREEKSIDE OAKS, SUITE 190 <br />CONTACT MAILING CITY 120. <br />SACRAMENTO <br />STATE 121_ <br />CA <br />ZIP CODE <br />95833 <br />-PRIMARY- IV. EMERGENCY <br />CONTACTS -SECONDARY- <br />NAME 127. <br />NAME 129. <br />NICHOLAS H. FISCHER <br />T—MOBILE WEST NOCC <br />TITLE 12; <br />TITLE � - <br />MANAGER— ENGINEERING <br />N/A <br />BUSINESS PHONE 125. <br />BUSINESS PHONE 1�0 <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: 133. <br />Billing Address: 1755 CREEKSIDE OAKS, SUITE 190 SACRAMENTO„ CA 95833 <br />Property Owner: Phone No.: ( ) <br />Certification: ed o y inquiry of th a ndividuals responsible for obtaining the information. I certify under penalty of law that I have personally examined and <br />am familiar with the • f ation submitt believe the information is true, accurate, and complete. <br />SIGNATURE OF O OPE TO O . DESIGN SENTATIVE <br />DATE 3d. <br />NAME OF DOCUMENT PREPARER <br />12/16/2011 <br />KELLY MICHAELS OF EAS <br />NAME OF SIGNER (p n) 136. <br />TITLE OF SIGNER 137, <br />NICHOLAS FISCHER <br />MANAGER— ENGINEERING <br />UN -020 V www.unidocs.org 5/17 - Rev. 12/14/10 <br />