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RECEIVE® <br />UNIFIED PROGRAM CONSOLIDATED FORM <br />0I <br />FACILITY INFORMATION <br />BUSINESS OWNER/OPERATOR IDENTIFICATION SAN JOAGUIN I <br />05/05/2009 - 08:42:53 AM FFICE OF R,� <br />Page of <br />1. IDENTIFICATION <br />FACILITY ID# 13773 <br />1 1 BEGINNING <br />DATE N/A 100 <br />ENDING DATE NSA <br />101 <br />BUSINESS NAME (Sarne as FACILITY NAME or DBA - Doing Business As) 3 <br />BUSINESS PHONE <br />102 <br />AT&T MOBILITY-HWY 4 & DRAIS RD <br />800-638-2822 *2 <br />BUSINESS E ADDRESS <br />103 <br />BUSINESS FAX <br />12a <br />18417 E HWY 4 <br />Not Collected <br />BUSINESS SITE CITY <br />104 <br />ZIP CODE 105 <br />COUNTY <br />108 <br />STOCKTON <br />CA <br />95215 <br />SAN JOAQUIN <br />DUN & BRADSTREET <br />106 <br />PRIMARY SIC 107 <br />PRIMARY NAICS <br />107a <br />10-202-6754 <br />4812 <br />Not Collected <br />BUSINESS MAILING ADDRESS <br />108a <br />4430 ROSEWOOD <br />DR <br />BUSINESS MAILING CITY <br />108 <br />STATE 108cZIP <br />CODE <br />I Ohl <br />PLEASANTON <br />CA 194588 <br />BUSINESS OPERATOR NAME <br />109 <br />BUSINESS OPERATOR PHONE <br />1 10 <br />AT&T MOBILITY <br />510-305-2553 <br />II. BUSINESS OWNER <br />OWNER NAME (14) <br />111 <br />OWNER PHONE (15) <br />1 1 _' <br />CINGULAR & NEW CINGULAR DBA <br />A T *.T 1.Tl%"TT T7 <br />510-305-2553 <br />1 <br />OWNER MAILING ADDRESS <br />11.1 <br />4430 ROSEWOOD DRIVE, BLDG3, 6TH FLR. <br />OWNER MAILING CITY <br />114 <br />STATE 115 <br />ZIP CODE <br />b <br />Hb <br />PLEASANTON <br />CA <br />94588 <br />III. ENVIRONMENTAL CONTACT <br />CONTACT NAME <br />117 <br />CONTACT PHONE <br />118 <br />EH&S - ANDREW TAYLOR <br />1 925-823-6161 <br />CONTACT MAILING ADDRESS <br />119 <br />CONTACT EMAIL <br />119a <br />2600 CAMINO RAMON <br />RM - <br />�rnnn <br />stephen.lockert@stantcc.cont <br />CONTACT MAILING CITY <br />120 <br />STATE 121 <br />ZIP CODE <br />122 <br />SAN RAMON <br />CA <br />94583 <br />IV. EMERGENCY CONTACTS <br />NAME ELLEN MAGNIE <br />123 NAME <br />ROBERT GARZA <br />128 <br />TITLE <br />COMPLIANCE MANAGER 124 TITLE <br />OPERATIONS MANAGERS <br />12 <br />BUSINESS PHONE 510-305-2553 <br />125 BUSINESS <br />PHONE 925-468-8499 <br />130 <br />24-HOUR PHONE 800-638-2822 *2 <br />126 24-HOUR <br />PHONE 866-435-7347 <br />131 <br />PAGER # 510-305-2553 <br />127 PAGER <br /># 415-999-2672 <br />132 <br />ADDITIONAL LOCALLY COLLECTED INFORMATION: <br />133 <br />COMPLETE PAGE 2 OF BUSINESS OWNER/OPERATOR IDENTIFICATION <br />Certification: Based on my inquiry of those individuals responsible for obtaining the information, l certify under penalty of law by signing below or certifying by the <br />established processes on the Administerting Agency's HMMP Compliance Website that 1 have personally examined and am familiar with the informaiton submitted and <br />believe the information is true, accurate, and complete. <br />SIGNATURE OF OWNER/OPERA ORD <br />ATED REPRESENTATIVE <br />DATE 4 E OF DOCUMENT PREPARER <br />l35 <br />01 <br />Vi AY 1 � <br />NAME OF SIGNE 136 <br />E <br />TITLE OF SIGNER <br />137 <br />V 5KAN DERSON <br />V <br />� - i�kT <br />UPCF (Rev. 12/2007) <br />IUNTY <br />I SERVICES <br />