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• <br /> L I I <br /> BUSINESS OWNER/OPERATOR IDENTIFICATION PAGE NO 2 4S985IDE i <br /> CALENDAR YEAR BEGINNING(1) ENDING(2) :• (31 PAGE l"OF� <br /> BUSINESS NAME (4) F_ -] BUSINES -- _ <br /> T/4c.0 Tae20`x - >7-5s�i <br /> SITE ADDRESS (6) <br /> :35-0 ) <br /> Street No. D rection Street Name Stree� A t/BldLJStlite <br /> CITY (7) STATE(8) C� ZIP(9) <br /> DUN & (10) SIC CODE(4 DIGIT#)(I1) / <br /> BRADSTREET <br /> OPERATOR (12) n ^ / I OPERATOR PHONE(13) <br /> NAME /7S /7 r/HCr ;s "SOC/- q-27-IS91- <br /> OWNERINFORMATION <br /> OWNER NAME(14) O WNER PHONE(I S) <br /> I3A(16) Fn�eh?I (Jen 707 - Sri- 1798 <br /> OWNER ADDRESS (16) <br /> (If different from Entries#6 or#41) V 0 U y i,3,5 1 Ro Cwt <br /> CITY(17) Ue `/ 0 STATE(18) 9 ZIP(19) <br /> ENVIRONMENTAL CONTACT <br /> CONTACT NAME(20) CONTAC PHONE (21) <br /> nv� goy-g.19- 906 )_ <br /> CONTACT ADDRESS (22) <br /> (If different from Entries#6 3 SQ� ( t J a m/n s� L <br /> 4+l E <br /> or#41) Street No. Direction Street Name Street Type <br /> A t/Bld Sutte <br /> CITY(23) STATE(24) ZIP(25) <br /> FS�o� IC /� Crszi5 <br /> Primary EMERGENCY CONTACTS Secondary <br /> NAME(26) NAME(31) <br /> (TO .A C 1'1,A 4 ��N� i,� Pe 0 e <br /> TITLE(27) _ _ TITLE(32) <br /> �74 <br /> BUSINESS PHONE(28) BUSINESS PHONE(33) <br /> ao� -y>>-ys8�. coq-y�7 9sga <br /> 24-HOUR PHONE(29) q q 24-HOUR PHONE(34) ((� _ <br /> (After Business Hours) a / / �� o Q (After Business Hours) 2 0 9 —9 S)— 5 b I <br /> PAGER#(30) Q69_ ?, O Q Z PAGER#(35) t , <br /> EXTREMELY HAZARDOUS SUBSTANCES/(EtIS) <br /> ON-SITE EHS (36) YES NO If yes,and above Threshold Quantities,attach a sheet of paper with a general <br /> description of the process and principle equipment. <br /> ADDITIONAL LOCALLY COLLECTED INFORMATION(37) Provide information requested on the back of this form <br /> NAME OF DOCUMENT PREPARER(38) <br /> c n/r % 4.! <br /> NAME OF OWNER/OPERATOR(39) C p t1 DATE(40) G <br /> —Zo- 7 �J <br /> SJC 12/97 <br />