Laserfiche WebLink
BUSINESS OWNER/OPERATOR IDENTI i A O )R11' Account#: 9450 <br /> 1. IDENTIFICATION <br /> BUSINESS NAME (4) BURGER KING #7628 BUSINESS PHONE(5) 209-367-7693 <br /> SITE ADDRESS (6) 18960 Nā‘ HWY 88 <br /> Street No. Direction Street Name Street Type A t/Bld Suite <br /> CITY (7) LOCKEFORD STATE(8) CA ZIP(9) 95237 <br /> DUN& (10) 890406719026220 SIC CODE(4 DIGIT#)(11) 5812 <br /> BRADSTREET <br /> OPERATOR (12) KNOX & ASSOCIATES OPERATOR PHONE(13) 209-367-7693 <br /> NAME <br /> II. BUSINESS OWNER <br /> OWNER NAME(14) KNOX & ASSOCIATES OWNER PHONE(15) 209-367-7693 <br /> OWNER MAILING ADDRESS(16) 633 E VICTOR RD <br /> (If different from site address) <br /> CITY(17) LODI STATE(18) CA ZIP(19) 95240 <br /> III. ENVIRONMENTAL CONTACT <br /> CONTACT NAME(20) TODD KNOX CONTACT PHONE(2 1) 209-367-7693 <br /> MAILING ADDRESS(22) <br /> (If different from business 633 IF <br /> VICTOR RD <br /> mailing address) Street No. Direction Street Name Street Type Apt/Bldg/Suite <br /> CITY(23) FL ODI STATE(24) E <br /> ZIP(25)F <br /> 0 <br /> Primary IV. EMERGENCY CONTACTS Secondary <br /> NAME(26) TODD KNOX NAME(3 1) DAVE KNOX <br /> TITLE(27) DIR OF MAINT TITLE(32) IDIR OF OPS <br /> BUSINESS PHONE(28) 209-367-7693 BUSINESS PHONE(33) 209-367-7693 <br /> 24-HOUR PHONE(29) 209-607-3200 24-HOUR PHONE(34) 209-483-1414 <br /> PAGER#(30) 209-775-7037 PAGER#(35) 209-775-7036 <br /> EXTREMELY HAZARDOUS SUBSTANCES (EHS) <br /> ON-SITE EHS (36) NQ 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) TODD KNOX <br /> NAME OF OWNER/OPERATOR(39) KNOX & ASSOCIATES DATE(40) 2/1/1999 <br /> DATE REC'D: 12/27/02 <br />