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FIFD PROGRAM CONSOLIDATED FORM Vqm( <br /> . FACILITY INFORMATION <br /> BUSINESS OWNER/OPERATOR IDENTIFICATION <br /> Modification Date:01/17/2012 <br /> Last Website Update: Page of <br /> 1. IDENTIFICATION <br /> FACILITY ID# 13066 1 BEGINNING DATE N/A 10Q ENDING DATE 101 <br /> NIA <br />` BUSINESS NAME(Same as FACILITY NAME or DBA-Doing Business As) 3 BUSINESS PHONE 102 <br /> 4 QUALITY TUNE UP SHOP#11 209-473-8863 <br /> BUSINESS SITE ADDRESS, .103 BUSINESS FAX 109, <br /> 7730 HOLMAN'RD Not Collected <br /> - <br /> BUSINESS SITE CITY 104 ZIP CODE 105 COUNTY 108 <br /> STOCKTON CA 95212 SAN JOAQUIN <br /> DUN&BRADSTREET 106 PRIMARY SIC 107 PRIMARY NAICS 107a <br /> 858638653 .7549 Not Collected <br />` BUSINESS MAILING ADDRESS 1081' <br /> 7730 HOLMAN RD <br /> j BUSINESS MAILING CITY 108.t STATE 108c ZIP CODE 108(1 <br /> STOCKTON CA 95212 <br /> BUSINESS OPERATOR NAME 109 BUSINESS OPERATOR PHONE 110 <br /> T.M.2004 QUALITY TUNE.-UP 209-473-8863 <br /> RHOPC T,T,(- <br /> 1I. BUSINESS OWNER <br /> OWNER NAME(14) 111 1 OWNER PHONE(15) 112 <br /> THE TOM MCVEY 2004 QUALITY TUNE-UP SHOPS LLC 209-473-8863 <br /> OWNER MAILING ADDRESS 113 <br /> 3031 STANFORD RANCH ROAD STE 2-144 <br /> OWNER MAILING CITY 114 STATE 1 15 ZIP CODE 116 <br /> ROCKLIN CA 95765 <br /> .III. ENVIRONMENTAL CONTACT <br /> CONTACT NAME 117 1 CONTACT PHONE 118 <br /> RON PRASAD 916-420-2841 <br /> CONTACT MAILING ADDRESS 119 CONTACT EMAIL 119a <br /> 27 BETHESDA CT 95838 gtuholman@yahoo.com <br /> CONTACT MAILING CH 120 STATE 121 ZIP CODE 122 <br /> SACRAMENTO CA 95828 <br /> IV. EMERGENCY CONTACTS <br /> NAME RON PRASAD 123 NAME 128 <br /> TOM MCVEY <br /> TITLE 124 TITLE 129 <br /> MANAGER OWNER <br /> BUSINESS PHONE 209-473-8863 125 BUSINESS PHONE 916-801-0829 130 <br /> 24-HOUR PHONE 916-420-2841 126 24-HOUR PHONE N/A 131 <br /> PAGER/CELL# N/A 127 PAGER/CELL# 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 Administerting 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 OWNERIOPERATOR OR DESIGNATED REPRESENTATIVE DATE 134 NAME OF DOCUMENT PREPARER 135 <br /> NAME OF SIGNER(print) 136 TITLE OF SIGNER 137 <br /> UPCF(Rev. 1212007) <br />