HomeMy WebLinkAbout906 SUMNER STREETUNIFIED PROGRAM CONSOLIDATED FORM
FACILITY INFORMATION
BUSINESS OWNER/OPERATOR IDENTIFICATION
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1. IDENTIFICATION
FACILITY ID# BEGINNING DATE Etl _'VIL108-01-2011
ENP4GT 101
BUSINESS NAME (Sarre as FACILITY NAME or DBA -Doing Business As) 3 BUSINESS PHONE 102
Qwest Communications Company, LLC dba Centurylink QCC- Bakersfield 206-346-7532
BUSINESS SITE ADDRESS 103 BUSINESS FAX 102a
906 Sumner St. 1 206-345-2079
BUSINESS SITE CITY 104 ZIP CODE 105 COUNTY 108
Bakersfield
CA
93304 Kern
DUN & BRADSTREET 106 PRIMARY SIC 107 PRIMARY NAICS 107a
14-872-1178 4813 517110
BUSINESS MAILING ADDRESS 108a
1600 71h Avenue, Room 712
BUSINESS MAILING CITY 108b STATE 108c ZIP CODE 108d
Seattle WA 1 98191
BUSINESS OPERATOR NAME 109
Oixii-,-,t Commjinit-ntinnz Ccimnnny T I C
BUSINESS OPERATOR PHONE 110
11. BUSINESS OWNER
OWNER NAME III OWNER PHONE 112
Owest Communications Company, LLC (a Delaware Comvany) 206-346-7532
OWNER MAILING ADDRESS 113
100 Centurylink Drive
OWNER MAILING CITY 114 STATE 115 ZIP CODE 116
Monroe LA 71203
III. ENVIRONMENTAL CONTACT
CONTACT NAME 117 CONTACT PHONE 118
Thomas Pitts 206-346-7532
CONTACT MAILING ADDRESS 119 CONTACT EMAIL 119a
1600 7th Avenue, Room 712 Thomas.p4tsoacenturylink.com
CONTACT MAILING CITY 120 STATE 121 ZIP CODE 122
Seattle WA 98191
PRIMARY- IV. EMERGENCY CONTACTS -SECONDARY-
NAME 123 NAME 128
UNICALL Earle Lyons
TITLE 124 TITLE 129
24-Hour Emergency Oi)erator Area Manager
BUSINESS PHONE 125 BUSINESS PHONE 130
866-864-2255 720 578 4060
24-HOUR PHONE 126 24-HOUR PHONE 131
866-864-2255 661 6454868
PAGER# 127 PAGER# 132
866-864-2255
ADDITIONAL LOCALLY COLLECTED INFORMATION: 133
Certification: Based on my inquiry of those individuals responsible for obtaining the information, I certify under penalty of law that I have personally examined and
am familiar with the information submitted and believe the information is true, accurate, and complete.
SIGNATURE OF OWNER T R DESIGNATED REPRESENTATIVE DATE 134 NAME OF DOCUMENT PREPARER 135
8/15/2011 I Thomas Pitts
NAME OFSIGNEP,1'pAt) 136 TITLEOFSIGNER 137
Thomas J. Pitts Environmental Health and Safety Manager