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count#: <br /> Ac9291 <br /> BUSINESS OWNER/OPERATOR IDENTIFICATION FORM primary Site#: E::= <br /> BEGINNING DATE(1) 2001 I. IDENTIFICATION DATE RECEIVED 1/19/01 <br /> BUSINESS NAME (4) MCDONALD'S #4111 BUSINESS PHONE(5) 209-478-0234 <br /> SITE ADDRESS (6) 611 CHARTER WAY F <br /> Street No. Direction Street Name Street T e I A�t/Bld /Suite <br /> CITY (7) STOCKTON STATE(8)F— <br /> CA ZIP(9) 95206 <br /> DUN& (10) 61-869-5134 SIC CODE(4 DIGIT#) (I I) 5812 <br /> BRADSTREET <br /> OPERATOR (12) DON SCHRADER OPERATOR PHONE(13) 209-478-0234 <br /> NAME <br /> II. BUSINESS OWNER <br /> OWNER NAME(I4) DON SCHRADER OWNER PHONE(15) 209-478-0234 <br /> OWNER MAILING ADDRESS(I6) 3846 PENINSULA CT <br /> (If different from site address) <br /> CITY(17) STOCKTON STATE(18) CA ZIP(19) 95219 <br /> III. ENVIRONMENTAL CONTACT <br /> CONTACT NAME(20) CRAIG SCHRADER CONTACT PHONE(2 1) 209-478-0234 <br /> MAILING ADDRESS(22) <br /> site address)4502 IF <br /> GEORGETOWN PL <br /> (If different from �J <br /> Street No. Direction Street Name Street Type A t/Bld /Suite <br /> CITY(23) FTOCKTON STATE(24) F <br /> ZIP(25)E:�: I <br /> Primary IV. EMERGENCY CONTACTS Secondary <br /> NAME(26) PAT JACQUEZ NAME(3l) DAN MOITOS 0 <br /> TITLE(27) TITLE(32) <br /> OPERATIONS MANAGER AREA SUP <br /> BUSINESS PHONE(28) 209-478-0234 BUSINESS PHONE(33) 209-478-0234 <br /> 24-HOUR PHONE(29) 209-473-8153 24-HOUR PHONE(34) 209-599-2324 <br /> PAGER#(30) 209-969-0313 PAGER#(35) 209-608-8300 <br /> EXTREMELY HAZARDOUS SUBSTANCES (ERS) <br /> ON-SITE EHS (36) NO If yes,and above Threshold Planning Quantities,attach a sheet of paper with a general <br /> description of the process and principle equipment. <br /> ADDITIONAL LOCALLY COLLECTED INFORMATION(37) Provide information requested on the back of this form <br /> NAME OF DOCUMENT PREPARER (38) KATHY NULL <br /> NAME OF OWNER/OPERATOR(39) DON SCHRADER DATE(40) 11/-3/1998 <br />