HomeMy WebLinkAboutBUSS OWNER/OPERATOR 12/31/200915-021-000653, SBC - SA532, 12/30/2008 5:52:04 PM
UNIFIED PROGRAM CONSOLIDATED FORM
FACILITY INFORMATION
BUSINESS OWNER/OPERATOR IDENTIFICATION
Page 1 of 1
I. IDENTIF[CATION
FACIUTY ID~ ~ BEGINNING DATE 100 ENDING DATE ~01
1 5 ,~ 0 2 1 ~~ 0 0 0 6 5 3 ~/1/2009 12/31/2009
~rF
~~
BUSINESSNAME~SamensFACILITYNAMEorD[lA- Doingl3usiness
As) 3 BUSINESSPHONE ~~n
SBC - SA532 8055467416
BUSINESS SITE ADDKESS 103
11101 WHITE LN
CITY ~~ ZIP CODE 105
BAKERSFIELD CA 93301
DUN & BRADSTREET 10G SIC CODE (4 digit #) 10'~
10-340-1618 4813
COUNTY 108
KERN
BUSINESS OPERATOR NAME ~~ BUSINESS OPERATOR PHONE ~~~
GRANT ARMSTRONG (661) 327-6903
11. I3USINESS O~VNER
OWNERNAME ~~~ OWNERPHONE 112
Pacific Bell Telephone Company dba AT8~T California (800) 566-9347
OWNER MAILING ADDRESS 113
PO BOX 5095, RM 3E000
CITY ~~^ STATE ~ 15 ZIP CODE ~ 16
SAN RAMON CA 94583-0995
III. ENVIRONMENTAL CONTACT
CONTACT NAME ~~~ CONTACT PHONE ~~S
GARY CHIMIENTI (925) 823-0725
CONTACT MAILING ADDRESS 119
PO BOX 5095, RM 3E000
CITY 120 STATE ~z~ ZIP CODE ~u
SAN RAMON CA 94583-0995
-PRIMtUiY- IV. EMERGENCY CONTACTS -SECONDARY-
NAME ~~ NAME ~~
GRANT ARMSTRONG EMERGENCY CTRL CTR
TITLE 120 TITLE ~29
ENV. SITE MANAGER 24 HR CALL CENTER
BUSINESS PHONE ~u BUSINESS PHONE i3o
(661) 327-6903 (877) 322-4722
24-HOUR PHONE ~~ 24-HOUR PHONE 13~
(800) 566-9347 (800) 566-9347
PAGER # ~Z~ PAGER # i32
(661) 721-4747
ADDITIONAL LOCALLY COLLECTED INFORMATION: i33
15-021-000653-SU B M ITTED-30-D EC EM B ER-08
Certification: Dased on my inquiry of those individuals responsible for obtaining the information, I certify under penalty of law tha[ 1 have personally examined and
am familiar with the infonnation submitted and be lieve the information is true, accurate, and complete.
SIGNATURE OF OWNGWOI'ERATOR OR DES NATED REPR ~NTATIVE DATE ~34 NAME OF DOCUMENT PREPARER 135
12/30/2008 STEPHEN LOCKERT
NAME OF SIGNER (prim) 136 TITLE OF SIGNER ~3~
STEVE SKANDERSON SR. PROJECT MANAGER
UPCF ( 1/99 revised) OES FORM 2730 (1/99)