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NIFIED PROGRAM CONSOLIDATED FO <br /> FACILITY INFORMATION <br /> BUSINESS OWNER/OPERATOR IDENTIFICATION <br /> Modification Date:05/07/2009 <br /> Last Website Update: 12/24/2008 Page_ of <br /> I. IDENTIFICATION <br /> FACILITY ID# 12301 1 1 BEGINNING DATE N/A 100 ENDING DATE N/A 101 <br /> BUSINESS NAME(Same as FACILITY NAME or DBA-Doing Business As) 3 BUSINESS PHONE 102 <br /> CRYSTAL VALLEY CELLARS LLC 209-759-3888 <br /> BUSINESS SITE ADDRESS 103 BUSINESS FAX <br /> 16750 E HWY 88 Not Collected <br /> BUSINESS SITE CITY 104 ZIP CODE 105 COUNTY 108 <br /> LOCKEFORD CA 95237 SAN JOAQUIN <br /> DUN&BRADSTREET 106 PRIMARY SIC 107 PRIMARY NAICS 107a <br /> 119729739 0172 Not Collected <br /> BUSINESS MAILING ADDRESS 108a <br /> P.O.BOX 1827 <br /> BUSINESS MAILING CITY 108 STATE I08c ZIP CODE 1085 <br /> WOODBRIDGE CA 95258-1827 <br /> BUSINESS OPERATOR NAME 109 BUSINESS OPERATOR PHONE 110 <br /> JASON FISHER 209-759-3888 <br /> II. BUSINESS OWNER <br /> OWNER NAME(14) 111 1 OWNER PHONE(15) 112 <br /> COSENTINO SIGNATURE ENT 707-9441220 <br /> OWNER MAILING ADDRESS 113 <br /> 7415 HWY 29 <br /> OWNER MAILING CITY 114 STATE 115 ZIP CODE 116 <br /> YOUNTVILLE CA 94599 <br /> III. ENVIRONMENTAL CONTACT <br /> CONTACT NAME 117 CONTACT PHONE 118 <br /> JASON FISHER 707-9441220 <br /> CONTACT MAILING ADDRESS 119 CONTACT EMAIL 119a <br /> 741529 jfisher@cosentinowineryxom <br /> CONTACT MAILING CITY 120 STATE 121 ZIP CODE 122 <br /> YOUNTVILLE CA 94599 <br /> IV. EMERGENCY CONTACTS <br /> NAME 123 NAME 128 <br /> JIM HEARTE MITCH COSENTINO I <br /> TITLE 124 TITLE 129 ) <br /> COO PRESIDENT <br /> BUSINESS PHONE 1-707-944-1220 125 BUSINESS PHONE 1-707 944 1220 130 <br /> 24-HOUR PHONE 1-530-263-2718 126 24-HOUR PHONE 1-707-480-9025 131 <br /> PAGER# N/A 127 PAGER# 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 Administeniag 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 TITLE OF SIGNER 137 <br /> UPCF(Rev.12/2007) <br />