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'EIV <br />UNIDOCS JAN 12 <br />FACILITY INFORMATION 201 <br />BUSINESS OWNER/OPERATOR IDENTIFICATION PAC4K SANJOAjIll <br />Page gNCYS£ <br />[. IDENTIFICATION <br />FACILITY [D # <br />BEGINNING DATE t00. <br />ENDING DATE tot• <br />(Agency Use Only) <br />BUSINESS NAME (Same as Facility Name or DBA -Doi Business As) 3. <br />BUSINESS PHONE 102. <br />T -MOBILE WEST CORPORATION SITE ID#SC07420A <br />UNMANNED FACILITY <br />BUSINESS SITE ADDRESS 103. <br />2 EAST JACKSON STREET <br />BUSINESS FAX 102a. <br />UNMANNED FACILITY <br />BUSINESS SITE CITY 104. <br />ZIP CODE 105• <br />COUNTY 108. <br />STOCKTON <br />CA <br />95206 <br />SAN JOAQUIN <br />DUN & BRADSTREET 106. <br />06-632-8376 <br />PRIMARY SIC 107. <br />PRIMARY NAICS 10ta <br />4812 <br />517212 <br />BUSINESS MAILING ADDRESS 10sa. <br />1755 CREEKSIDE OAKS, SUITE 190 <br />BUSINESS MAILING CITY 108b. <br />STATE 109c <br />ZIP CODE 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 />II. BUSINESS OWNER <br />OWNERNAME T -MOBILE WEST CORPORATION 111' <br />OWNER PHONE. 117. <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 />llt. ENVIRONMENTAL CONTACT <br />CONTACT NAME 117. <br />CONTACT PHONE 118. <br />MICHELLE STEFFLER <br />(916)643-8979 <br />CONTACT MAILING ADDRESS 119. <br />CONTACT EMAIL 1194 <br />1755 CREEKSIDE OAKS, SUITE 190 <br />CONTACT MAILING CITY '0 SACRAMENTO <br />STCA ATE 121. <br />ZIP CODE 95833 122 <br />-PRIMARY- IV. EMERGENCY <br />CONTACTS -SECONDARY- <br />NAME 1' � <br />NAME Izs. <br />NICHOLAS H. FISCHER <br />T -MOBILE WEST NOCC <br />TITLE 124. <br />TITLE 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 />PAGER# N/A 127. <br />PAGER# 132. <br />( N/A <br />ADDITIONAL LOCALLY CO1,1 FCTED INFORMATION: 133. <br />Billing Address: 1755 CREEKSIDE OAKS, SUITE 190 SACRAMENTO,, CA 95833 <br />Property O er: Phone No.: ( ) <br />Certificatio asedmy inquiry of those individuals responsible for obtaining the information, I certify under penalty of law that I have personally examined and <br />am familiar wi he in rmation submitted and believe the information is true, accurate, and complete. <br />SIGNATURE O O PERAT NATED REPRESENTATIVE <br />DATE 134. <br />NAME OF DOCUMENT PREPARER 135. <br />12/16/2011 <br />KELLY MICHAELS OF EAS <br />NAME OF SIG E (print) 136. <br />TITLE OF SIGNER 137. <br />NICH S H. FISCHER <br />MANAGER- ENGINEERING <br />UN -020 - www.unidocs.org 5/17 -Rev. 12/14/10 <br />MES <br />