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TIFIGATkOi 1" i R „ r Account#: <br /> I. IDENTIFICATION <br /> BUSINESS NAME (4) BUSINESS PHONE(5) 09-759-3888 <br /> RYSTAL VALLEY CELLARS LLC <br /> sITEADDRESs (6) 16750 WY 88 E <br /> Street No. Direction street Name street UB dg/Suite <br /> CITY (7) OCKEFORD STATE(8)FA7 ZIP(9) 5237 <br /> SIC CODE(4 DIGIT#)(11) 172 <br /> BRADSTREET (10) 119729739 <br /> OPERATOR (12) OPERATOR PHONE(13) 09-759-3888 <br /> NAME ASON FISHER <br /> II.BUSINESS OWNER <br /> OWNER NAME(14) OWNER PHONE(15) <br /> OSENTINO SIGNATURE ENT 07-944-1220 <br /> OWNER MAILING ADDRESS(16) 415 HWY 29 <br /> (If different from site address) <br /> CITY (17) OUNTVILLE 71 STATE(18) El ZIP(19) 4599 71 <br /> III. ENVIRONMENTAL CONTACT <br /> CONTACT NAME(20) ASON FISHER CONTACT PHONE(2 1) 07-944-1220 <br /> MAILING ADDRESS(22) F different from business <br /> 41529 <br /> mailing address) <br /> Street No. [Di—rec t i JStreet Name Street Type ApUB g Swte <br /> CITY(23) OUNTVILLE STATE(24) ZIP(25)F] 4599 <br /> Primary IV. EMERGENCY CONTACTS Secondary <br /> NAME(26) NAME(3 1) <br /> IM HEARTS ITCH COSENTINO <br /> TITLE(27) TITLE(32) <br /> 00 RESIDENT <br /> BUSINESS PHONE(28) 1-707-944-1220 BUSINESS PHONE(33) 1-707 944 1220 <br /> 24-HOUR PHONE(29) 1-530-263-2718 24-HOUR PHONE(34) 1-707-480-9025 <br /> PAGER#(30) /A PAGER#(35) /A <br /> EXTREMELY HAZARDOUS SUBSTANCES (EHS) <br /> ON-SITE EHS (36) If yes,and above Threshold Planning Quantities,attach a sheet of paper with a general <br /> description of the process and principle equipment involving the EHS. <br /> ADDITIONAL LOCALLY COLLECTED INFORMATION(37) Provide information requested on the back of this form <br /> NAME OF DOCUMENT PREPARER(38) HANE SOLDINGER,JULIE WEINSOCK,JEFF LEBARD <br /> NAME OF OWNER/OPERATOR(39) OSENTINO SIGNATURE DATE(40) <br /> NTERPRISED,LTD.,LLC <br /> DATE REC'D: 3/20/08 <br />