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UNIFIED PROGRAM CONSOLIDATED FO <br /> FACILITY INFORMATION <br /> BUSINESS OWNER/OPERATOR IDENTIFICATION <br /> Modification Date:05/07/2009 <br /> Last Website Update: 2/21/2008 Page_ of_ <br /> 1. IDENTIFICATION <br /> FACILITY ID# 10513 1 1 BEGINNING DATE N/A 100 ENDING DATE 101 <br /> N/A <br /> BUSINESS NAME(Same as FACILITY NAME or DBA-Doing Business As) 3 BUSINESS PHONE 102 <br /> FARIAS AUTO REPAIR 209-570-2081 <br /> BUSINESS SITE ADDRESS 103 BUSINESS FAX <br /> 2029 E CHEROKEE RD Not Collected <br /> BUSINESS SITE CITY 104ZIP CODE 105 FcOUM'Y 108 <br /> STOCKTON CA 95205 SAN JOAQUIN <br /> DUN&BRADSTREET 106 PRIMARY SIC 107 PRIMARY NAICS 107a <br /> 101663719 7538 Not Collected <br /> BUSINESS MAILING ADDRESS 108-. <br /> BUSINESS MAILING CITY 108 STATE 101c ZIP CODE 108d <br /> BUSINESS OPERATOR NAME 109 BUSINESS OPERATOR PHONE 110 <br /> N/A N/A <br /> 11. BUSINESS OWNER <br /> OWNER NAME(14) 111 1 OWNER PHONE(15) 112 <br /> JOSE FARIAS 209-570-2081 <br /> OWNER MAILING ADDRESS 113 <br /> 1823 CHEROKEE ROAD SPC.#1 <br /> OWNER MAILING CITY 114 STATE 115 ZIP CODE 116 <br /> STOCKTON CA 95205 <br /> III. ENVIRONMENTAL CONTACT <br /> CONTACT NAME 117 CONTACT PHONE 118 <br /> RAMON FARIAS 209-570-2081 <br /> CONTACT MAILING ADDRESS 119 CONTACT EMAIL 119 <br /> 1823 CHEROKEE RD #1 alicfar2099msn.com <br /> CONTACT MAILING CITY 120 STATE 121 ZIP CODE 122 <br /> STOCKTON CA 95205 <br /> IV. EMERGENCY CONTACTS <br /> NAME ALICIA FARIAS 123 NAME SYLVIA FARIAS 128 <br /> 1 <br /> TITLE 124 TITLE 129 <br /> ASST MGR ASST MGR <br /> BUSINESS PHONE 209-464-5600/209-271-4701 125 BUSINESS PHONE N/A 130 <br /> 24-HOUR PHONE 209-467-4761 126 24-HOUR PHONE 209-808.6422 131 <br /> PAGER# 209-271-4701(CELL) 127 PAGER# N/A IT <br /> ADDITIONAL LOCALLY COLLECTED INFORMATION: 133 <br /> COMPLETE PAGE 2 OF BUSINESS OWNER/OPERATOR IDENTIFICATION <br /> Certification: Based on my inquiry of those individuals responsible for obtaining the information,I certify under penalty of law by signing below or certifying by the <br /> established processes on the Administcr ing Agency's HMMP Compliance Website that I have personally examined and am familiar with the informaiton submitted and <br /> believe the information is true,accurate,and complete. <br /> SIGNATURE OF OWNER/OPERATOR OR DESIGNATED REPRESENTATIVE DATE 134 1 NAME OF DOCUMENT PREPARER 135 <br /> NAME OF SIGNER(print) 136 FITLEOFSIGNER 137 <br /> UPCF(Rev.12/2007) <br />