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IED PROGRAM CONSOLIDATED FORM <br /> FACILITY INFORMATION <br /> BUSINESS OWNER/OPERATOR IDENTIFICATION <br /> Modification Date:03/22/2011 <br /> Last Website Update: 1/24/2008 Page of <br /> 1. IDENTIFICATION <br /> FACILITY ID# 6985 1 BEGINNING DATE N/A 100 1 ENDING DATE N/A 101 <br /> BUSINESS NAME(Same as FACILITY NAME or DBA-Doing Business As) 3 BUSINESS PHONE 102 <br /> OFF ROAD ENTERPRISES 209-931-1170 <br /> BUSINESS SITE ADDRESS 103 BUSINESS FAX <br /> 2953 CHERRYLAND AVE #B Not Collected <br /> BUSINESS SITE CITY 104 ZIP CODE 105 COUNTY 108 <br /> STOCKTON CA 95215.2233 SAN JOAQUIN <br /> DUN&BRADSTREET 106 PRIMARY SIC 107 PRIMARY NAICS 107 <br /> 112720313 7549 Not Collected <br /> BUSINESS MAILING ADDRESS 108 <br /> BUSINESS MAILING CITY 108t STATE 108 1 <br /> ZIP CODE 108d <br /> BUSINESS OPERATOR NAME 109 BUSINESS OPERATOR PHONE 110 <br /> WADE MARTIN 209-931-1170 <br /> II. BUSINESS OWNER <br /> OWNER NAME(14) 111 1 OWNER PHONE(15) 112 <br /> WADE MARTIN (209)969-7178 <br /> OWNER MAILING ADDRESS 113 <br /> 3261 CHERRYLAND AVE. <br /> OWNER MAILING CITY 114 STATE 11 ZIP CODE 116 <br /> STOCKTON CA 95215 <br /> III. ENVIRONMENTAL CONTACT <br /> CONTACT NAME 117 CONTACT PHONE 118 <br /> WADE MARTIN 209-931-1170 <br /> CONTACT MAILING ADDRESS 119 CONTACT EMAIL 119 <br /> 3261 CHERRYLAND AVE w4wdmartin@aol.com <br /> CONTACT MAILING CITY 120 STATE 121 ZIP CODE 122 <br /> STOCKTON CAL 95215 <br /> IV. EMERGENCY CONTACTS <br /> NAME 123 NAME 128 <br /> WADE MARTIN N/A <br /> TITLE OWNER N/A 124 TITLE 129 <br /> BUSINESS PHONE 209-931-1170 125 BUSINESS PHONE N/A 130 <br /> 24-HOUR PHONE 209-969-7178 126 24-HOUR PHONE N/A 131 <br /> PAGER/CELL# N/A 127 PAGER/CELL# N/A 132 <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 Administering Agency's HMMP Compliance Website that I have personally examined and am familiar with the iaformanon submitted and <br /> believe the information is we,accurate,and complete. <br /> SIGNATURE OF OWNER-- ERATOR OR DESIGNATED REPRESENTATIVE DATE 134 1 NAME OF DOCUMENT PREPARER 135 <br /> NAME OF SIGNER(print) 136 TITLE OF SIGNER 137 <br /> UPCF Rev. 12/2007 <br />