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9001 STOCKDALE HWY (2)
RZ BUSINESS ACTIVITIES KERN COUNTY ENVIRONMENTAL HEALTH SERVICES 2011 Unified Program Consolidated Form (UPCF) DEPARTMENT FACILITY INFORMATION2700MSTREET, SUITE 300 BAKERSFIELD, CA 93301 661 862 -8700 Fax 661 862 -8701 Page 1 of I. FACILITY IDENTIFICATION FACILITY ID # (Agency Useonly) 1 EPA ID # (Hazardous Waste Only) 2 BUSINESS NAME (Same as Facility Name of DBA -Doing Business As) 3 T - Mobile West Corporation (SITE # SV00011A ) BUSINESS SITE ADDRESS 9001 Stockdale HWY 103 BUSINESS SITE CITY Bakersfield 104 ZIP CODE 105 CA 93311 II. ACTIVITIES DECLARATION NOTE: If you check YES to any part of this list, lease submit the Business Owner/Operator Identification page KC Form 2730). Does your facility... IfYes, please com lete these pages ofthe UPCF.... A. HAZARDOUS MATERIALS 4 Have on site (for any purpose) at any one time, hazardous materials at or above HAZARDOUS MATERIALS INVENTORY 55 gallons for liquids, 500 pounds for solids, or 200 cubic feet for compressed 3 YES [I NO CHEMICAL DESCRIPTION gases (include liquids in ASTs and USTs); or the applicable Federal threshold CONSOLIDATED CONTINGENCY PLANquantityforanextremelyhazardoussubstancespecifiedin40CFRPart355, Appendix A or B; or handle radiological materials in quantities for which an SITE MAP emergency lan is required pursuant to 10 CFR Parts 30, 40 or 70? B. REGULATED SUBSTANCES 4a Have Regulated Substances stored onsite in quantities greater than the threshold CalARP — REGULATED SUBSTANCE quantities established by the California Accidental Release prevention Program YES x NO REGISTRATION (KC Form2736) CalARP)? C. UNDERGROUND STORAGE TANKS (USTs) 5 UST FACILITY (KC Form A) Own or operate underground storage tanks? DYES ® NO UST TANK (one page per tank) (KC Form B) D. ABOVE GROUND PETROLEUM STORAGE 8 Own or operate ASTs above these thresholds: Store greater than 1,320 gallons of petroleum products (new or used) in YES ®NO NO FORM REQUIRED TO KCEHSD aboveground tanks or containers. E. HAZARDOUS WASTE 9 EPA ID NUMBER — provide at the top of Generate hazardous waste? YES 0 NO this page HAZ WASTE GENERATOR FORM Recycle more than 100 kg/month of excluded or exempted recyclable 10 YES [N No RECYCLABLE MATERIALS REPORT materials (per HSC 25143.2)? oneperrecycler) (KC Form 2732) t t ON -SITE HAZARDOUS WASTE TREATMENT— FACILITY (KC Form 17720 Treat hazardous waste on -site? YES ® NO ON -SITE HAZARDOUS WASTE TREATMENT — UNIT (one page permit) KC Form 1772u Treatment subject to financial assurance requirements (for Permit by Rule and 12 YES NO CERTIFICATION OF FINANCIAL Conditional Authorization)? ASSURANCE (KCForm 1232) Consolidate hazardous waste generated at a remote site? YES ®NO 13 REMOTE WASTE / CONSOLIDATION SITE ANNUAL NOTIFICATION Need to report the closure /removal of a tank that was classified as 14 HAZARDOUS WASTE TANK CLOSURE hazardous waste and cleaned on -site? YES ® NO CERTIFICATION Generate in any single calendar month 1,000 kilograms (kg) (2,200 pounds) or 14, Obtain federal EPA ID Number, file more of federal RCRA hazardous waste, or generate in any single calendar YES F1 NO Biennial Report (EPA Form 8700 - month, or accumulate at any time, 1 kg (2.2 pounds) ofRCRA acute hazardous 13A/B), and satisfy requirements for waste; or generate or accumulate at any time more than 100 kg (220 pounds) of RCRA Large Quantity Generator. spill cleanup materials contaminated with RCRA acute hazardous waste. Household Hazardous Waste (HHW) Collection site? YES ®NO 14b NO FORM REQUIRED TO KCEHSD F. LOCAL REQUIREMENTS 15 A copy of the facility's Contingency /Emergency Response Plan is to be included with the original submission of the Business Plan. KCEHSD is to be informed of any revisions to the plan. Please contact KCEHSD at the above number for assistance in completing the plan. 05/2008 revised KC Form2729 Business Owner /Operator Identification Please submit the Business Activities page (KC Form 2729), the Business Owner /Operator Identification page (KC Form 2730), and Hazardous Materials Inventory - Chemical Description pages (KC Form 273 1) for all hazardous materials inventory submissions. For the inventory to be considered complete this page must be signed by the appropriate individual. (Note: the numbering of the instructions follows the data element numbers that are on the Unified Program Consolidated Form (UPCF) pages. These data element numbers are used for electronic submission and are the same as the numbering used in Division 3, Electronic Submittal ofInformation.) Please number all pages ofyour submittal. This helps the Kern County Environmental Health Services Department (KCEHSD) identify whether the submittal is complete and ifany pages are separated. 1 FACILITY ID NUMBER — Leave this blank. This number is assigned by KCEHSD. This is the unique number which identifies your facility. 3 BUSINESS NAME - Enter the doing business as name. 100 BEGINNING DATE - Enter the beginning year and date ofthe report. (YYYYMMDD) 101 ENDING DATE - Enter the ending year and date ofthe report. (YYYYMMDD) 102 BUSINESS PHONE - Enter the phone number, area code first, and any extension. 102a BUSINESS FAX— Enter the business fax number, area code first. 103 BUSINESS SITE ADDRESS - Enter the street address where the facility is located. No post office box numbers are allowed. This information must provide a means to geographically locate the facility. 104 BUSINESS SITE CITY - Enter the city or unincorporated area in which business site is located. 105 ZIP CODE - Enter the zip code ofbusiness site. The extra 4 digit zip may also be added. 106 DUN & BRADSTREET — Ifsubject to EPCRA, enter the Dun & Bradstreet number for the facility. The Dun & Bradstreet number may be obtained by calling 610) 882 -7748 or on the web at www.dnb.com. 107 SIC NUMBER - Enter the primary Standard Industrial Classification System Number. Required for EPCRA. 107a NAICS NUMBER - Enter the primary North American Industrial Classification System Number. 108 COUNTY - Enter the county in which the business site is located. 108a BUSINESS MAILING ADDRESS — Enter the mailing address to be used for all official business correspondence. This mailing address must be filled in. 108b BUSINESS MAILING CITY - Enter the name of the city for the business mailing address. 108c STATE - Enter the two character abbreviation ofthe state for the business mailing address. 108d ZIP CODE - Enter the zip code for the business mailing address. The extra 4 digit zip may also be added. 109 BUSINESS OPERATOR NAME - Enter the name of the business operator. 110 BUSINESS OPERATOR PHONE - Enter business operator phone number, if different from business phone, area code first, and any extension. 111 BUSINESS OWNER NAME - Enter name ofbusiness owner, if different from business operator. 112 BUSINESS OWNER PHONE - Enter the business owner's phone number if different from business phone, area code first, and any extension. 113 BUSINESS OWNER MAILING ADDRESS - Enter the owner's mailing address, ifdifferent from business mailing address. 114 BUSINESS OWNER CITY - Enter the name of the city for the owner's mailing address, if different from business mailing address. 115 BUSINESS OWNER STATE - Enter the 2 character state abbreviation for the owner's mailing address, ifdifferent from business mailing address. 116 BUSINESS OWNER ZIP CODE - Enter the zip code for the owner's address, ifdifferent from business mailing address. The extra 4 digit zip may also be added. 117 ENVIRONMENTAL CONTACT NAME - Enter the name of the person, who receives all environmental correspondence. 118 CONTACT PHONE - Enter the phone number, ifdifferent from Owner or Operator, for the environmental contact, area code first, and any extension. 119 CONTACT MAILING ADDRESS - Enter the mailing address where all environmental contact correspondence should be sent. 119a CONTACT EMAIL — Enter the email address ofthe environmental contact in 117, if the contact has one. 120 CONTACT MAILING CITY - Enter the name ofthe city for the environmental contact's mailing address. 121 STATE - Enter the 2 character state abbreviation for the environmental contact's mailing address. 122 ZIP CODE - Enter the zip code for the environmental contact's mailing address. The extra 4 digit zip may also be added. 123 PRIMARY EMERGENCY CONTACT NAME - Enter the name of a representative to be contacted in case there is an emergency involving hazardous materials at the business site. The contact shall have FULL facility access, site familiarity, and authority to make decisions for the business regarding incident mitigation. 124 TITLE - Enter the title ofthe primary emergency contact. 125 BUSINESS PHONE - Enter the business number for the primary emergency contact, area code first, and any extensions. 126 24 -HOUR PHONE - Enter a 24 -hour phone number for the primary emergency contact. The 24 -hour phone number must be one which is answered 24 hours a day. If it is not the contact's home phone number, then the service answering the phone must be able to immediately contact the individual stated above. 127 PAGER NUMBER - Enter the pager number for the primary emergency contact, ifavailable. 128 SECONDARY EMERGENCY CONTACT NAME - Enter the name of a secondary representative that can be contacted in the event thatthe primary emergency contact is not available. The contact shall have FULL facility access, site familiarity, and authority to make decisions for the business regarding incident mitigation. 129 TITLE - Enter the title ofthe secondary emergency contact. 130 BUSINESS PHONE - Enter the business telephone number for the secondary emergency contact, area code first, and any extension. 131 24 -HOUR PHONE - Enter a 24 -hour phone number for the secondary emergency contact. The 24 hour phone number must be one which is answered 24 hours a day. If it is not the contact's home phone number, then the service answering the phone must be able to immediately contact the individual stated above. 132 PAGER NUMBER - Enter the pager number for the secondary emergency contact, ifavailable. 133 ADDITIONAL LOCALLY COLLECTED INFORMATION - Please include the Assessor's Parcel Number (APN) for the actual facility location. 134 DATE - Enter the date that the document was signed. (YYYYMMDD) 135 NAME OF DOCUMENT PREPARER - Enter the full name ofthe person who prepared the inventory submittal information. 136 NAME OF SIGNER - Enter the full printed name ofthe person signing the page. The signer certifies to a familiarity with the information submitted and that based on the signer's inquiry ofthose individuals responsible for obtaining the information, all the information submitted is true, accurate and complete. SIGNATURE OF OWNER/ OPERATOR OR DESIGNATED REPRESENTATIVE - The Business Owner /Operator, or officially designated representative of the Owner /Operator, shall sign in the space provided. This signature certifies that the signer is familiar with the information submitted and that based on the signer's inquiry of those individuals responsible for obtaining the information it is the signer's beliefthat the submitted information is true, accurate and complete. 137 TITLE OF SIGNER - Enter the title of the person signing the page. 05/2008 revised) KC Form 2730 BUSINESS OWNER/OPERATOR IDENTIFICATION KERN COUNTY ENVIRONMENTAL HEALTH SERVICES DEPARTMENT Unified Program Consolidated Form (UPCF) 2700 M STREET, SUITE 300 FACILITY INFORMATION BAKERSFIELD, CA 93301 661 862 -8700 Fax 661 862 -8701 Page _of_ I. IDENTIFICATION FACILITY ID# I BEGINNING DATE 100 1 ENDING DATE 101 BUSINESS NAME (s. e; u FACILITY NAMEorDBA— Doing Business As) 3 BUSINESS PHONE 102 T - Mobile West Corporation (SITE # SV00011A ) N/A unmanned facility BUSINESS SITE ADDRESS 103 BUSINESS FAX Iota 9001 Stockdale HWY N/A BUSINESS SITE CITY 104 ZIP CODE 105 COUNTY 108 Bakersfield CA 93311 KERN DUN & BRADSTREET 106 PRIMARY SIC 107 PRIMARY NAICS 107a 06- 632 -8376 4812 BUSINESS MAILING ADDRESS Iola 12920 SE 38th Street BUSINESS MAILING CITY 108b STATE 108e ZIP CODE 108d Bellevue WA 98006 BUSINESS OPERATOR NAME 109 BUSINESS OPERATOR PHONE 110 Carmen Martinez 925 - 521 -5952 II. BUSINESS OWNER OWNER NAME 111 OWNER PHONE 112 T - Mobile West Corporation 425) 383 -4000 OWNER MAILING ADDRESS 113 12920 SE 38th Street OWNER MAILING CITY 114 STATE 115 ZIP CODE 116 Bellevue WA 98006 III. ENVIRONMENTAL CONTACT CONTACT NAME 117 CONTACT PHONE 118 Carmen Martinez 925 - 521- 5952 CONTACT MAILING ADDRESS 119 CONTACT EMAIL 119a 1855 Gateway BLVD, 10th Floor N/A CONTACT MAILING CITY 120 STATE 121 ZIP CODE 122 Concord CA 94520 PRIMARY- IV. EMERGENCY CONTACTS -SECONDARY - NAME 123 NAME 128 Miguel Martinez T- Mobile West NOCC TITLE 124 TITLE 129 Engineering - Field Manager N/A BUSINESS PHONE 125 BUSINESS PHONE 130 805) 584 -5716 888) 662 -4662 24 -HOUR PHONE 126 24 -HOUR PHONE 131 888) 662 -4662 888) 662 -4662 PAGER # 127 PAGER # 132 N/A N/A ADDITIONAL LOCALLY COLLECTED INFORMATION: 133 APN: - - - Certification: Based on my inquiry ofthose individuals responsible for obtaining the information, I certify under penalty oflaw that I have personally examined and am familiar with the information submitted and believe the information is true, accurate, and complete. SIGNATURE OF OWNER/OPERATOR OR DESIGNATED REPRESENTATIVE DATE 134 NAME OF DOCUMENT PREPARER 135 44,_m 7/16/10 Angela Keel - EWS1 NAME OF SIGNER (print) 136 TITLE OF SIGNER 137 Carmen Martinez Regional Compliance Manager 05/2008 revised) KC Form 2730 Hazardous Materials Inventory - Chemical Description You must complete a separate Hazardous Materials Inventory - Chemical Description page for each hazardous material (hazardous substances and hazardous waste) that you handle at your facility in aggregate quantities equal to or greater than 500 pounds, 55 gallons, 200 cubic feet of gas (calculated at standard temperature and pressure) or the federal threshold planning quantity for Extremely Hazardous Substances, whichever is less. Also complete a page for each radioactive material handled over quantities for which an emergency plan is required to be adopted pursuant to 10 CFR Parts 30, 40, or 70. The completed inventory should reflect all reportable quantities of hazardous materials at your facility, reported separately for each building or outside adjacent area, with separate pages for unique occurrences ofphysical state, storage temperature and storage pressure. (Note: the numbering ofthe instructions follows the data element numbers that are on the Unified Program Consolidated Form (UPCF) pages. These data element numbers are used for electronic submission and are the same as the numbering used in Division 3, Electronic Submittal ofInformation.) Please number all pages of your submittal. This helps the Kern County Environmental Health Services Department (KCEHSD) identify whether the submittal is complete and if any pages are separated. 1 FACILITY ID NUMBER - This number is assigned by KCEHSD. This is the unique number which identifies your facility. 3 BUSINESS NAME - Enter the full legal name of the business. 200 ADD /DELETE/ REVISE - Indicate if the material is being added to the inventory, deleted from the inventory, or ifthe information previously submitted is being revised. NOTE: You may choose to leave this blank ifyou resubmit your entire inventory annually. 201 CHEMICAL LOCATION -Enter the building or outside/ adjacent area where the hazardous material is handled. A chemical that is stored at the same pressure and temperature, in multiple locations within a building, can be reported on a single page. NOTE: This information is not subject to public disclosure pursuant to HSC §25506. 202 CHEMICAL LOCATION CONFIDENTIAL - EPCRA - All businesses which are subject to the Emergency Planning and Community Right to Know Act (EPCRA) must check "Yes" to keep chemical location information confidential. Ifthe business does not wish to keep chemical location information confidential check "No ". 203 MAP NUMBER - if a map is included, enter the number ofthe map on which the location ofthe hazardous material is shown. 204 GRID NUMBER -Ifgrid coordinates are used, enter the grid coordinates ofthe map that correspond to the location ofthe hazardous material. If applicable, multiple grid coordinates can be listed. 205 CHEMICAL NAME -Enter the proper chemical name associated with the Chemical Abstract Service (CAS) number ofthe hazardous material. This should be the International Union ofPure and Applied Chemistry (IUPAC) name found on the Material Safety Data Sheet (MSDS). NOTE: Ifthe chemical is a mixture, do not complete this field; complete the "COMMON NAME" field instead. 206 TRADE SECRET - Check "Yes" if the information in this section is declared a trade secret, or "No" if it is not. State requirement: If yes, and business is not subject to EPCRA, disclosure ofthe designated trade secret information is bound by HSC §25511. Federal requirement: Ifyes, and business is subject to EPCRA, disclosure ofthe designated Trade Secret information is bound by 40 CFR and the business must submit a "Substantiation to Accompany Claims ofTrade Secrecy" form (40 CFR 350.27) to USEPA. 207 COMMON NAME - Enter the common name ortrade name of the hazardous material or mixture containing a hazardous material. 208 EHS -Check "Yes" ifthe hazardous material is an Extremely Hazardous Substance (EHS), as defined in 40 CFR, Part 355, Appendix A. Ifthe material is a mixture containing an EHS, leave this section blank and complete the section on hazardous components below. 209 CAS # -Enter the Chemical Abstract Service (CAS) number for the hazardous material. For mixtures, enter the CAS number of the mixture if it has been assigned a number distinct from its components. If the mixture has no CAS number, leave this column blank and report the CAS numbers ofthe individual hazardous components in the appropriate section below. 210 FIRE CODE HAZARD CLASSES - Fire Code Hazard Classes describe to first responders the type and level ofhazardous materials which a business handles. This information is not currently required by KCEHSD. A list of the hazard classes and instructions on howto determine which class a material falls under are included in the appendices ofArticle 80 of the Uniform Fire Code. Ifa material has more than one applicable hazard class, include all. 211 HAZARDOUS MATERIAL TYPE -Check the one box that best describes the type of hazardous material: pure, mixture or waste. Ifwaste material, check only that box. Ifmixture or waste, complete hazardous components section. 212 RADIOACTIVE - Check "Yes" ifthe hazardous material is radioactive or "No" ifit is not. 213 CURIES -If the hazardous material is radioactive, use this area to report the activity in curies. You may use up to nine digits with a floating decimal point to report activity in curies. 214 PHYSICAL STATE - Check the one box that best describes the state in which the hazardous material is handled: solid, liquid or gas. 215 LARGEST CONTAINER - Enter the total capacity ofthe largest container in which the material is stored. 216 FEDERAI. HAZARD CATEGORIES - Check all cateeories that describe the nhvsical and health hazards associated with the hazardous material. PHYSICAL HAZARDS HEALTH HAZARDS Fire: Flammable Liquids and Solids, Combustible Liquids, ro horics, Oxidizers Acute Health (Immediate): Highly Toxic, Toxic, Irritants, Sensitizers, Corrosives, other hazardous chemicals with an adverse effect with short term exposureReactive: Unstable Reactive Organic Peroxides, Water Reactive, Radioactive Pressure Release: Explosives, Compressed Gases, Blasting Agents Chronic Health (Delayed): Carcinogens, other hazardous chemicals with an adverse effect with long term exposure 217 AVERAGE DAILY AMOUNT - Calculate the average daily amount ofthe hazardous material or mixture containing a hazardous material, in each building or adjacent/ outside area. Calculations shall be based on the previous year's inventory ofmaterial reported on this page. Total all daily amounts and divide by the number of days the chemical will be on site. Ifthis is a material that has not previously been present at this location, the amountshall be the average daily amountyou projectto be on hand during the course ofthe year. This amount should be consistent with the units reported in box 221 and should not exceed that of maximum daily amount. 218 MAXIMUM DAILY AMOUNT - Enter the maximum amount ofeach hazardous material or mixture containing a hazardous material, which is handled in a building or adjacent/outside area at any one time over the course ofthe year. This amount must contain at a minimum last year's inventory ofthe material reported on this page, with the reflection ofadditions, deletions, or revisions projected for the current year. This amount should be consistent with the units reported in box 221. 219 ANNUAL WASTE AMOUNT - Ifthe hazardous material being inventoried is a waste, provide an estimate ofthe annual amount handled. 220 STATE WASTE CODE - Ifthe hazardous material is a waste, enter the appropriate California 3 -digit hazardous waste code as listed on the back ofthe Uniform Hazardous Waste Manifest. 221 UNITS - Check the unit of measure that is most appropriate for the material being reported on this page: gallons, pounds, cubic feet or tons. NOTE: Ifthe material is a federally defined Extremely Hazardous Substance (EHS), all amounts must be reported in pounds. If material is a mixture containing an EHS, report the units that the material is stored in (gallons, pounds, cubic feet, or tons). 222 DAYS ON SITE - List the total number ofdays during the year that the material is on site. 223 STORAGE CONTAINER -Check all boxes that describe the type ofstorage containers in which the hazardous material is stored. NOTE: If appropriate, you may choose more than one. 224 STORAGE PRESSURE - Check the one box that best describes the pressure at which the hazardous material is stored. 225 STORAGE TEMPERATURE - Check the one box that best describes the temperature at which the hazardous material is stored. 226 HAZARDOUS COMPONENTS 1-5 (% BY WEIGHT) - Enter the percentage weight of the hazardous component in a mixture. Ifa range of percentages is available, report the highest percentage in that range. (Report for components 2 through 5 in 230, 234, 238, and 242.) 227 HAZARDOUS COMPONENTS 1 -5 NAME - When reporting a hazardous material that is a mixture, list up to five chemical names ofhazardous components in that mixture by percent weight (refer to MSDS or, in the case oftrade secrets, refer to manufacturer). All hazardous components in the mixture present at greater than 1% by weight if non - carcinogenic, or 0.1 % by weight if carcinogenic, should be reported. Ifmore than five hazardous components are present above these percentages, you may attach an additional sheet ofpaper to capture the required information. When reporting waste mixtures, mineral and chemical composition should be listed. (Report for components 2 through 5 in 231, 235, 239, and 243.) 228 HAZARDOUS COMPONENTS 1 -5 EHS - Check "Yes" if the component ofthe mixture is considered an Extremely Hazardous Substance as defined in 40 CFR, Part 355, or "No" ifit is not. (Report for components 2 through 5 in 232, 236, 240, and 244.) 229 HAZARDOUS COMPONENTS 1 -5 CAS - List the Chemical Abstract Service (CAS) numbers as related to the hazardous components in the mixture. (Repeat for2 -5.) 246 LOCALLY COLLECTED INFORMATION - Currently, no additional information is required by KCEHSD. 5/2008 revised) KC Form 2731 UNIFIED PROGRAM CONSOLIDATED FORM HAZARDOUS MATERIALS HAZARDOUS MATERIALS INVENTORY - CHEMICAL DESCRIPTION one page per material per building orarea) Ann nFI FTF REVISE 200 Page 1. FACILITY INFORMATION BUSINESS NAME (Same as FACILITY NAME or DBA - Doing Business As) 3 T - Mobile West Corporation (site # SV00011A ) CHEMICAL LOCATION Cabinet 3 201 CHEMICAL LOCATION CONFIDENTIAL - Yes No 202 EPCRA FACILITY ID ,1 1 MAP # (optional) 203 GRID # (optional) 204 11. CHEMICAL INFORMATION CHEMICAL NAME Electrolyte Battery Containing Sulfuric Acid 205 TRADE SECRET El Yes P9 No 206 If Subject to EPCRA, refer to instructions COMMONNAME Battery Corp (BC- 12V26FT X 4) 207 EHS' LFYes 0N 208 CAS # 7664-93-9 209 If EHS is'Yes', all amounts below must be in FIRE CODE HAZARD CLASSES (Complete if required by CUPA) 210 COR HAZARDOUS MATERIAL a. PURE 93 b. MIXTURE El c. WASTE 211 RADIOACTIVE Yes ® No 212 CURIES 213 TYPE (Check one item only) PHYSICAL STATE a. SOLID ® b. LIQUID c. GAS 214 LARGEST CONTAINER 4 X 20.5 1bB = 82 lb5 215 Check oneitem only) FED HAZARD CATEGORIES a. FIRE ® b. REACTIVE c. PRESSURE RELEASE d. ACUTE HEALTH e. CHRONIC HEALTH 216Checkallthatapply) AVERAGE DAILY 217821bS MAXIMUM Dtl ` 218 v1bS ANNUAL WASTE N/A 219 STATE WAYE 220 AMOUNT AMOUNT AMOUNT CODE UNITS' a. GALLONS b. CUBIC FEET c. POUNDS d. TONS 221 DAYS ON 222 Check one item only) ' If EHS, amount must be in pounds. SITE 3 6 5 STORAGE CONTAINER a. ABOVEGROUND TANK ED a. PLASTIC/NONMETALLIC DRUM I. FIBER DRUM m. GLASS BOTTLE q. RAILCAR 223Checkallthatapply) b. UNDERGROUND TANK f. CAN j. BAG n. PLASTIC BOTTLE ® r. OTHER c. TANK INSIDE BUILDING g. CARBOY k. BOX o. TOTE BIN d. STEEL DRUM h. SILO I. CYLINDER p. TANK WAGON STORAGE PRESSURE E1 a. AMBIENT b. ABOVE AMBIENT c. BELOW AMBIENT 224 STORAGE TEMPERATURE ER a. AMBIENT b. ABOVE AMBIENT c. BELOW AMBIENT d. CRYOGENIC 225 WT HAZARDOUS COMPONENT (Formixture orwaste only) EHS CAS # 1 50 0 226 Lead 227 0 Yes No 228 7439 -92 -1 229 2 21% 230 Lead Oxide 231 X1 Yes No 232 1309 -60 -0 233 3 22% 234 Dilute Sulferic Acid Electrolyte 235 Yes El NoNo 236 237 4 238 239 Yes No 240 241 5 242 243 Yes No 244 245 Ifmorehazardous components are presentat greaterthan 1% byweight ifnon - carcinogenic, or 0.1% by weight ifcarcinogenic, attach additional sheets ofpaper capturing the required Information. ADDITIONAL LOCALLY COLLECTEDINFORMATION: 246 If EPCRA, Please Sign Here UPCF (1/99) OES FORM 2731 (1/99) UNIFIED PROGRAM CONSOLIDATED FORM HAZARDOUS MATERIALS HAZARDOUS MATERIALS INVENTORY- CHEMICAL DESCRIPTION onepage per materialper building or area) f-1 nnn I-I nFl FTr RFVICF qnn Page I. FACILITY INFORMATION BUSINESS NAME (Same as FACILITY NAME or DBA - Doing Business As) 3 T - Mobile West Corporation (site # SV00011A ) CHEMICAL LOCATION Cabinet 2 201 CHEMICAL LOCATION El PSYes NoCONFIDENTIAL - 202 EPCRA FACILITY ID # 1 MAP # (optionao 203 GRID # (optional) 204 II. CHEMICAL INFORMATION CHEMICAL NAME Electrolyte Battery Containing Sulfuric Acid 205 TRADE SECRET El Yes ® No 206 If Subject to EPCRA, refer to instructions COMMON NAME Enersys (SBS C-11 X 4) 207 EHS' Oyes No 208 CAS # 7664-93-9 209 If EHS is'Yes', all amounts below must be in FIRE CODE HAZARD CLASSES (Complete itrequired by CUPA) 210 COR HAZARDOUS MATERIAL a. PURE ZI b. MIXTURE c. WASTE 211 RADIOACTIVE Yes ® No 212 CURIES 213 TYPE (Checkone item only) PHYSICAL STATE a. SOLID ® b. LIQUID c. GAS 214 LARGEST CONTAINER 4 X 61.6 lbs = 246.4 lbs 215 Check one item only) FED HAZARD CATEGORIES a. FIRE ® b. REACTIVE c. PRESSURE RELEASE d. ACUTE HEALTH e. CHRONIC HEALTH 216Checkallthatapply) AVERAGE DAILY 217 246 lbs MAXIMUM 'N6.4 218lbs ANNUAL WASTE N/A 219 STATE WA TE 220 AMOUNT .4 AMOUNT AMOUNT CODE UNITS' a. GALLONS b. CUBIC FEET IN c. POUNDS d. TONS 221 DAYS ON 222 Check one item only) ' If EHS, amount must be in pounds. SITE 365 STORAGE CONTAINER a. ABOVEGROUND TANK e. PLASTIC/NONMETALLIC DRUM i. FIBER DRUM m. GLASS BOTTLE q. RAIL CAR 223Checkallthatapply) b. UNDERGROUND TANK [If. CAN j. BAG n. PLASTIC BOTTLE El r. OTHER c. TANK INSIDE BUILDING g. CARBOY k. BOX o. TOTE BIN d. STEEL DRUM Cl h. SILO 1:11. CYLINDER p. TANK WAGON STORAGE PRESSURE [} a. AMBIENT b. ABOVE AMBIENT c. BELOWAMBIENT 224 STORAGE TEMPERATURE 12 a. AMBIENT b. ABOVE AMBIENT c. BELOWAMBIENT d. CRYOGENIC 225 WT HAZARDOUS COMPONENT (Formixture orwaste only) EHS CAS# 1 600 226 Lead 227 Yes ®No 228 7439 -92 -1 229 2 17.5 %230 Lead Oxide 231 X1 Yes No 232 1309 -60 -0 233 3 7.5% 234 Dilute Sulferic Acid Electrolyte 235 Yes El No 236 7664 -93 -9 237 4 238 239 Yes No 240 241 5 242 243 El YesYes No 244 Ifmore hazardouscomponents arepresentat greater than 1% by weightifnon - carcinogenic, or 0.1% byweight ifcarcinogenic, attach additional sheets ofpapercapturing the required information. ADDITIONAL LOCALLY COLLECTED INFORMATION: 246 If EPCRA, Please Sign Here UPCF (1/99) OES FORM 2731 (1/99) HAZARDOUS MATERIALS INVENTORY - CHEMICAL DESCRIPTION KERN COUNTY ENVIRONMENTAL HEALTH SERVICES DEPARTMENT Unified Program Consolidated Form (UPCF) 2700 M STREET, SUITE 300 HAZARDOUS MATERIALS BAKERSFIELD, CA 93301 661 862 -8700 Fax 661 862 -8701 (onepage per material per buildingor area) ADD DELETE REVISE zoo Page of I. FACILITY INFORMATION BUSINESS NAME (Same as FACILITY NAME or DBA— Doing Business As) 3 T - Mobile West Corporation (SITE # SVOOOIIA) CHEMICAL LOCATION 201 CHEMICAL LOCATION CONFIDENTIAL EPCRA 202 Cabinet 1 YES NO1 1 MAP# (optional) 203 GRID# (optional) 204 FACILITY ID # 1 II. CHEMICAL INFORMATION CHEMICAL NAME 205 TRADE SECRET Yes © No 206 Electrolyte Battery Containing Sulfuric Acid If Subject to EMU, refer to instructions COMMON NAME 207 zoa Northstar (NSB100FT x 4) EHS* © Yes [] No If EHS is "Yes ", all amounts below must be in lbs. CAS# 209 7664 -93 -9 FIRE CODE HAZARD CLASSES (Not currentlyrequired by KCEHSD) 210 COR HAZARDOUS MATERIAL 211 212 RADIOACTIVE El Yes No 213 CURIES TYPE (Check one item only) a. PURE [ b. MIXTURE E] c. WASTE PHYSICAL STATE 214 Check one item only) a. SOLID b. LIQUID c. GAS 215 LARGEST CONTAINER 4 x 76.8 Ibs = 3 07.2 Ibs FED HAZARD CATEGORIES 216 Check all that apply) a. FIRE M b. REACTIVE c. PRESSURE RELEASE d. ACUTE HEALTH e. CHRONIC HEALTH AVERAGE DAILY AMOUNT 217 MAXIMUM DAILY AMOUNT 218 ANNUAL WASTE AMOUNT 219 STATE WASTE CODE 220 307.2 Ibs 307.2 Ibs1 N/A1 0 UNITS* a. GALLONS b. CUBIC FEET ® C. POUNDS d. TONS 221 1 DAYS ON SITE: 222 Check one item only) * If EHS, amount must be in pounds. 365 STORAGE CONTAINER 223 a. ABOVE GROUND TANK e. PLASTICINONMETALLIC DRUM i. FIBER DRUM m. GLASS BOTTLE q. RAIL CAR b. UNDERGROUND TANK f CAN j. BAG n. PLASTIC BOTTLE ®r. OTHER c. TANK INSIDE BUILDING g. CARBOY k. BOX o. TOTE BIN d. STEEL DRUM h. SILO I. CYLINDER p. TANK WAGON STORAGE PRESSURE ® a. AMBIENT b. ABOVE AMBIENT c. BELOW AMBIENT 224 STORAGE TEMPERATURE ® a. AMBIENT b. ABOVE AMBIENT c. BELOW AMBIENT d. CRYOGENIC 225 WT HAZARDOUS COMPONENT (For mixture or waste only) EHS CAS # 226 227 228 229 1 50% Lead Yes Q No 7439 -92 -1 230 231 232 233 2 20% Lead Oxide Yes © No 1309 -60 -0 234 235 236 237 3 17% Dilute Sulfuric Acid Electrolyte Yes No 7664 -93 -9 238 239 240 241 4 Yes No 242 243 244 245 5 Yes No Ifmore hazardous components are present at greaterthan 1% by weight ifnon - carcinogenic, or0.1 % by weight if carcinogenic, attach additional sheets ofpapercapturing the required information. ADDITIONAL LOCALLY COLLECTED INFORMATION 246 If EPCRA Please Sign Here 5/2008 revised) KC Form 2731 ADVISORY Page of The site - specific Contingency Plan is the facility's plan for handling emergencies and shall be implemented immediately whenever there is a fire, explosion, or release of hazardous materials or waste that could threaten human health and/or the environment. The contingency plan shall be reviewed, and immediately amended, if necessary, whenever: 4 The plan fails in an emergency 4 The facility changes in its design, construction, operation, maintenance, or other circumstances in a way that materially increases the potential for fires, explosions, or releases of hazardous waste or hazardous waste constituents, or changes the response necessary in an emergency 4 List of emergency coordinators changes 4 List of emergency equipment changes Submit a copy of any updates or changes to this Department. II. EMERGENCY CONTACTS PRIMARY SECONDARY NAME Miguel Martinez 123 128NAME - Mobile West NOCC TITLE Engineering - Field Manager 124 TITLE N/A 129 BUSINESS PHONE 125 BUSINESS PHONE 130 805)584 -5716 888) 662 -4662 24 -HOUR PHONE 126 24 -HOUR PHONE 131 888) 662 -4662 888) 662 -4662 PAGER # N 127 PAGER # 132 A N/A III. EMERGENCY RESPONSE PLANS AND PROCEDURES A. Notifications Your business is required by State Law to provide an immediate verbal report of any release or threatened release of a hazardous material to local fire emergency response personnel, this Department, and the California Emergency Management Agency. If you have a release or threatened release of hazardous materials, immediately call: FIRE /PARAMEDI CS/POLICE /SHERIFF PHONE: 911 AFTER the local emergency response personnel are notified, you shall then notify this Department and the California Emergency Management Agency. Kern County Environmental Health Department: (661) 862 -8700 or after hours, call Dispatch at (661) 861 -2521 California Emergency Management Agency: (800) 852 -7550 or (916) 845 -8911 National Response Center: (800 ) 424 -8802 Information to be provided during notification: d Your name and the telephone number from where you are calling. d Exact address of the release or threatened release. d Date, time, cause, and type of incident (e.g. fire, air release, spill etc.) 4 Material and quantity of the release, to the extent known. 4 Current condition of the facility. 4 Extent of injuries, if any. d Possible hazards to public health and/ or the environment outside ofthe facility. B. Emergency Medical Facility Page of List the closest emergency medical facility that will be used by your business in the event of an accident of injury caused by a release or threatened release of a hazardous material HOSPITAL /CLINIC: PHONE NO: Mercy Medical Center 661-663 - ADDRESS: 400 Old River Road CITY: ZIP CODE: Bakersfield 93311 -9781 C. Private Emergency Response DOES YOUR BUSINESS HAVE A PRIVATE ON -SITE EMERGENCY RESPONSE TEAM? El Yes No Ifyes, provide an attachment that describes wharpolicies and procedures your business will follow to notify your on -site emergency response team in the event of a release or threatened release of hazardous materials. CLEANUP /DISPOSAL CONTRACTOR List the contractor that will provide cleanup services in the event of a release. NAME OF CONTRACTOR: PHONE NO: CURA 800 _579_ 2872 ADDRESS: N/A CITY: ZIP CODE: N/A N/A D. Arrangements with Emergency Responders Ifyou have made special (i.e. contractual) arrangements with any police department, fire department, hospital, contractor, or State or local emergency response team to coordinate emergency services, describe those arrangements in the space below: E. Evacuation Plan 1. The following alarm signal(s) will be used to begin evacuation of the facility (check all which apply): Verbal ® Telephone (including cellular) X Alarm System 0 Public Address System ® Intercom Pagers D. Portable Radio Other (spec): 2. Evacuation map is prominently displayed throughout the facility. 3. Name of individual(s) responsible for coordinating evacuation including spreading the alarm and confirming the business has been evacuated: F. Earthquake Vulnerability Identify areas of the facility where releases could occur or would require immediate inspection or isolation because of the vulnerability to earthquake related ground motion. Hazardous Waste/ Hazardous Materials Storage Areas Production Floor Process Lines Bench/ Lab Waste Treatment Other: Identify mechanical systems where releases could occur or would require immediate inspection or isolation because of the vulnerability to earthquake related ground motion. Utilities Sprinkler Systems Cabinets Shelves Racks Pressure Vessels Gas Cylinders Tanks Process Piping Shutoff Valves Other: G. Emergency Procedures Page of Briefly describe your business standard operating procedures in the event ofa release or threatened release of hazardous materials /wastes: 1. PREVENTION (prevent the spill /release) - Consider the types of spills /releases associated with the hazardous materials /wastes present at your facility. What actions does your business take to prevent these spills /releases from occurring? You may include a discussion of safety and storage procedures. Hazardous materials at site consist of "sealed" batteries within a heavily sealed self - contained cabinet preventing accidental release. 2. MITIGATION (stop the release /spill) - Describe what actions are taken to reduce the harm or the damage to person(s), property, or the environment, and prevent what has occurred from getting worse or spreading. What is your immediate response to a leak, spill, fire, explosion, or airborne release at your business? Evacuate any necessary employee's from area of spill. Technician will immediately contact CURA 1- 800 - 579 -2872, (24/7/365) followed by call to supervisor. If possible, attempt containment efforts. 3. ABATEMENT (clean up the spill /release) - Describe what you would do to clean up the spill/release. How do you handle the complete process of cleaning up and disposing of released materials at your facility? Contact cleanup Contractor CURA at (800) 579 -2872 (24/7/365) dI2010 09:30 FAX 805 587 5720 T- MOBILE Training: Check all boxes which apply. 1. Personnel are trained in the following procedures: 1 001/00I Internal alarm/notitication o azar ous materials Evacuation/ re-en procedures assembly point locations mer enc mci en re o In LK External emergency response or aniza on notrncation -- oca ions and contents- ot Emergency es onse on in en an 2. Chemical Handlers are annually trained in the following: bate methods tor handlinq and storage o azar ous materials 19 Location(s) and pro er use OT Tire and spill control a u1 men roce ures emer enc pro ce ures tg Proper use o personal protective equipment Specific azar s ot each chemical o which ey may Be exposed, including routes ot exposure i.e. inhalation ingestion, absorption) Hazarclous waste Hanrilersimanagers are trained in all aspects of azar ous was e management specific to their job duties (e.g., conmineraccumulation «me requirements, labeling requirements, storage area bupeclion requirements, manifesting requirements, etc) 3. Emergency Response Team Members are capable of and engaged in the following: Personnel rescue roce ures u own o o era ions Liaison with responding agencies IX use, maintenance, and replacementreplacem!ant ot emergency response equipment e res er training, w is is rovided at eas annually Emergency response drills, which are conducted at eas (specvy; e.g., "Quarterly,, etc) Annually Amendment of Contingency Plan: This plan must be reviewed, and immediately amended, if necessary, whenever: a. Applicable regulations are revised. b. The plan fails in an emergency. C. The facility changes its design, construction, operation, maintenance, or other circumstances in a way that materially increases the potential for fires, explosions, o'r releases of hazardous waste or hazardous waste constituents, or changes the response necessary in an emergency. d. The list of emergency coordinators changes. e. The list of emergency equipment changes. o / E- mrges Coordinator Signature 7116110 Date IV. Emergency Equipment Page _ of 22 CCR, Section 66265.52(e) [as referenced by Section 66262.34(a)(3)] requires that emergency equipment at the facility be listed. Completion of the following Emergency Equipment Inventory Table meets this requirement. EMERGENCY EQUIPMENT INVENTORY TABLE 1. Equipment Category 2. Equipment Type 3. Location 4. Description* Personal Protective, Cartridge Respirators Chemical Monitoring Equipment (describe) Equipment, Safety Chemical Protective Aprons/Coats Chemical Protective Boots Equipment, and Chemical Protective Gloves Chemical Protective Suits (describe) First Aid Face Shields Equipment First Aid Kits /Stations (describe) Hard Hats Plumbed Eye Wash Stations Portable Eye Wash Kits (i.e. bottle type) Respirator Cartridges describe Safety Glasses/Splash Goggles Safety Showers Self-Contained Breathing Apparatuses (SCBA) Nicosh N -95 Facia Mask Other describe Fire Automatic Fire Sprinkler Systems Extinguishing Systems Fire Alarm Boxes /Stations Fire Extinguisher Systems (describe) A, B, C Fire Extinguiser Other describe Spill Control Equipment Absorbents (describe) Berms/Dikes describe Decontamination Equipment (describe) and Decontamination Emergency Tanks describe Exhaust Hoods Equipment Gas Cylinders Leak Repair Kits (describe) Neutralizers (describe) Overpack Drums Sums (describe) Other (describe) Communications Chemical Alarms (describe) and Intercoms/ PAS stems Alarm Portable Radios Systems Telephones Underground Tank Leak Detection Monitors Other (describe) S out out Additional Equipment Use Additional Pages if Needed.) Describe the equipment and its capabilities. lfapplicable, specify any testing /maintenance procedures /intervals. Attach additional pages, numbered appropriately, ifneeded. Page of V. EMPLOYEE TRAINING All facilities which handle hazardous materials must have a current written employee training plan. The items listed below are required per Health and Safety Code Section 25504 (c) and Title 19 Section 2732. Training shall be provided: 4 Initially for all new employees. 4 Methods for Safe Handling of Hazardous Materials. Note: These training programs may take into consideration the position ofeach employee. Facility personnel are trained as follows: 4 Familiarity with all plans and procedures specified in the Contingency Plan. d Methods for Safe Handling of Hazardous Materials. d Safety procedures in the event of a release or threatened release of a hazardous material. 4 Use of Emergency Response equipment and supplies under the control ofthe business. 4 Procedures for Coordination with local Emergency Response Organizations. Additional training should include: 4 Internal alarm /notification procedures. 4 Evacuation/re -entry procedures and assembly point locations 4 Material Safety Data Sheet (MSDS) training including specific hazard(s) of each chemical to which employees may be exposed, including routes ofexposure (i.e. inhalation, ingestion, absorption). VI. HAZARDOUS WASTE GENERATOR TRAINING If your business is a hazardous waste generator, you are required to provide training in hazardous waste management for all workers who handle hazardous waste at your site (22 CCR §66265.16). You are also required to document training. The items below are required. EMPLOYEE TRAINING 4 Facility personnel will successfully complete training within six months after the date of their employment or assignment to a facility or to a new position at a facility. d Employees will not handle hazardous wastes without supervision until trained. TRAINING DOCUMENTATION The owner or operator must maintain the following documents and records at the facility: 4 Job title for each position at the facility that is related to hazardous waste management, and the names of the employee(s) filling the position(s). d Description for each position listed above (must include required skill, education, or other qualifications as well as duties of employees assigned to the position. 4 Description of type and amount of both introductory and continuing training given to each employee. d Records that document that the requirements for training orjob experience have been met. 4 Current employees' training records (to be retained until closure ofthe facility). 4 Former employees' training records to be retained at least three years after termination ofemployment). T- Mobile Hazard Communications Training Course Summary (a /o March 20101 T- Mobile employees who in the line of their job description or duties are exposed to any chemical are required to participate in the online Hazard Communications Training Course at minimum once a year. The course objectives and brief description of the purpose of the standard are outlined below: Learning Objectives: After completing the online course, employee will be able to: Understand the purpose of the Hazard Communication Standard Recognize who is covered by the Hazard Communication Standard State the four basic parts of the Hazard Communication Standard (Hazard determination or assessment; the written program, M,SDS and labels and training) Identify physical and health hazards of chemicals List what items should be included in a hazardous chemical inventory Recognize what should be included in the written Hazard Communication program and what is the appropriate PPE to be used with any given possible chemical exposure. Recognize the information contained in a material safety data sheet (MSDS) and how it is used and maintained in the workplace and be able to identify the NFPA signage requirement and rating systems used in labeling. (i.e.; Blue, Red, Yellow and White as well as W and OX) Purpose of the Hazard Communication Standard: The OSHA HazCom Standard is found in 29 CFR 1910.1200 Requires employers to find all of the potential hazards of materials in the workplace and to tell their employees about those hazards Makes sure that employers and employees know the hazards of chemicals they work with and how to protect themselves (reducing injuries and illnesses due to hazardous chemicals). Ensures that the hazards of all chemicals produced in or imported into the US are examined, and that the requirements for hazard communication in the workplace are the same everywhere in the country. Hazard Communication Training Course Summary.doc 3 -23 -30 -cmtz INTENTIONALLY LEFT BLANK TRAINING RECORDS NEEDED FROM PROJECT POC SITE MAP A site plan and storage map must be included with your Contingency Plan. For relatively small facilities, these documents may be combined into one drawing. Since these drawings are intended for use in emergency response situations, larger facilities (generally those with complex and/or multiple buildings) should provide an overall site plan and a separate storage map for each building /storage area. A blank Facility Site Map has been provided on the reverse side of this page. You may complete that page or attach any other drawing(s) which contain(s) the information required below. Drawings are to be no larger than 11" x 17 ". Blue prints are not acceptable. 1. Site Plan: This drawing shall contain, at a minimum, the following information: a. Site orientation (North, South, etc.) b. Date the map was drawn C. Locations of all buildings and other structures d. Parking lots and internal roads e. Outside hazardous materials storage or use areas f. Storm drain, sanitary sewer drain inlets, and dry wells g. All wells (water, monitoring of underground tank systems, etc) if applicable h. Evacuation routes, emergency exits, and staging/meeting areas i. Adjacent property use j. Locations and names of adjacent streets and alleys k. Entrance and exit points /roads 2. Storage Map(s): The map(s) shall contain, at a minimum, the following information: a. General purpose of each section /area within each building (e.g. "Office Area ", "Manufacturing Area ", etc) b. Location of each hazardous material /waste storage, dispensing, use, or handling area (e.g. individual underground tanks, aboveground tanks, storage rooms, etc.). C. Entrances to and exits from each building and hazardous material /waste room/area d. Location of each utility emergency shut -off point (i.e. gas, water, electric) e. Location of each monitoring system control panel (e.g. underground tank monitoring, toxic gas monitoring, etc) Pending Construction Drawings from Project POC 7/16110 CONSOLIDATED CONTINGENCY PLAN KERN COUNTY ENVIRONMENTAL HEALTH SERVICES DEPARTMENT Unified Program Form 2700 M STREET, SUITE 300 SITE MAP BAKERSFIELD, CA 93301 661 862 -8700 Fax 661 862 -8701 Page of I. FACILITY IDENTIFICATION FACILITY ID # I I I I I I I I I I EPA ID # (Hazardous Waste Only) 2 BUSINESS NAME (Same as Facility Name of DBA -Doing Business As) 3 T - Mobile West Corporation (SITE # SV00011A ) SITE ADDRESS 103 CITY 104 ZIP CODE 105 9001 STOCKDALE HWY Bakersfield 93311 DATE MAP DRAWN MAP # SUB - FACILITY # (ifneeded) For Site Map Loading Areas Parking Lots Internal Roads Storm and Sewer Drains Adjacent Property Use Locations and Names of Adjacent Streets and Alleys Entrance and Exit Points and Roads Evacuation Routes For Storage Map Location ofEach Storage Area Location ofEach Hazardous Material Handling Area Location of Emergency Response Equipment NORTH San Luis Obispo County Certified Unified Program Agency FORM M - MAP GRID (see instruction page v) Map # Scale: 1 inch= Feet Business Name: T - Mobile west Corporation (SITE # SV00011A ) Date: 7/16/10 Address: 9001 Stockdale HWY Bakersfield, CA 93311 Number of Employees in Facility Depicted Above - Day = N/A Night = N/A unmanned facility 4 Page Of C: \Documents and Settings \rhendry\ Desktop \CUPA_Files \cups \forms \FRM -M.DOC 07/09/09 C i Cerit& ma e , 20 "21iy.Q_ata t, OC,. A,, 09 AS - IF 001,5 . 0CKDAlUAE'HWY;8AKERSF1ECD:: M 3 3,11., 4AP 7 i wr00, I V, 44N I Jj W .4IT:k r-- 1 <'a Uff no62 N -719,-05 23 Eyealtyealtyealtyealtyealt _da951 It San Luis Obispo County Certified Unified Program Agency FORM M - MAP GRID (see instruction page v) Map # Scale: 1 inch= Feet Business Name: T - Mobile west Corporation (SITE # SV00011A ) Date: 7/16/10 Address: 9001 Stockdale HWY Bakersfield, CA 93311 Number of Employees in Facility Depicted Above - Day = N/A Night =N /A unmanned facility 4 Page Of CADocuments and Settings \rhendry\ Desktop \CUPA_Files \cupa \forms \FRM -M.DOC 07/09/09