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Account#: 3880 <br /> I. IDENTIFICATION <br /> BUSINESS NAME (4) ATHROP SHELL BUSINESS PHONE(5) 09-983-0381 <br /> SITE ADDRESS (6) 16500 HARLAN <br /> Street No. Direction Street Name Street Type Apt BI <br /> CITY (7) ATHROP STATE(8) A� ZIP(9) 5330 <br /> DUN & (10) 4-8564975 SIC CODE(4 DIGIT#)(11) 541 <br /> BRADSTREET <br /> OPERATOR (12) OPERATOR PHONE(13) <br /> NAME INICK ARBABIAN 09-478-9583 <br /> II. BUSINESS OWNER <br /> OWNER NAME(14) ICK ARBABIAN OWNER PHONE(15) 09-478-9583 <br /> OWNER MAILING ADDRESS(16) <br /> (If different from site address) .O.BOX 690514 <br /> CITY (17) TOCKTON STATE(18) El ZIP(19) 5269-0514 <br /> III. ENVIRONMENTAL CONTACT <br /> CONTACT NAME(20) ICK ARBABIAN CONTACT PHONE(21) 09-478-9583 <br /> MAILING ADDRESS (22) <br /> (If different from business 04 ATHERINE AY <br /> mailing address) IF <br /> Street No. Direction Street Name treet ype p g w[e <br /> CITY (23) STATE(24) ZIP(25) <br /> FSTOCKTON El <br /> 5209 <br /> primary IV. EMERGENCY CONTACTS Secondary <br /> NAME(26) NAME(3 1) <br /> ICK ARBABIAN �OB MACDONALD <br /> TITLE(27) TITLE(32) <br /> 1OWNER ISTRICT MANAGER <br /> BUSINESS PHONE(28) BUSINESS PHONE(33) <br /> 09-983-0381 06-706-2345 <br /> 24-HOUR PHONE(29) 24-HOUR PHONE(34) <br /> 09-478-9583 916-215-7676 <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) ICK ARBABIAN <br /> NAME OF OWNER/OPERATOR(39) INICK ARBABIAN DATE(40) 10/4/2004 <br /> DATE REC'D: 10/5/07 <br />