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JAN j h LU(14 <br /> BUSINESS OWNER/OPER,ATOWIDFNTIFICA I ION FORM Account#: 8474 <br /> I. IDENTIFICATION <br /> %,,SINESS NAME (4) RIPON, CITY F PUBLIC W BUSINESS PHONE(5) 209-599-2108 <br /> WELLS (#10) <br /> SITE ADDRESS (6) 1310 ❑ HUGHES LN <br /> Street No. Direction Street Name Street T e A t/BId SuiteS��uite JJ <br /> CITY (7) RIPON STATE(8)FA ZIP(9) 95366 <br /> DUN& (10) 004952156 SIC CODE(4 DIGIT#)(11) 4941,4852 <br /> BRADSTREET <br /> OPERATOR (12) TED JOHNSTON OPERATOR PHONE(13) 209-599-2108 <br /> NAME <br /> II. BUSINESS OWNER <br /> OWNER NAME(14) CITY OF RIPON OWNER PHONE(15) 209-599-2108 <br /> OWNER MAILING ADDRESS(16) 1210 S VERA AVE <br /> (If different from site address) <br /> CITY(17) � N STATE(18) CA ZIP(19) 95366 <br /> I"Tl� III. ENVIRONMENTAL CONTACT <br /> CONTACT NAME(20) TED JOHNSTON CONTACT PHONE(21) 209-599-2151 <br /> MAILING ADDRESS(22) <br /> ling <br /> tfromess) mess 1210 IF <br /> VERA7AVE <br /> ling address) <br /> Street No. Direction Street Name Street type A UBId Suite <br /> CITY(23) RIPON STATE(24) CA ZIP(25) 95366 <br /> Primary IV. EMERGENCY CONTACTS Secondary <br /> NAME(26) TED JOHNSTON NAME(3 1) DEAN BLACK <br /> TITLE(27) PUBLIC WORKS DIRECTOR TITLE(32) PUBLIC WORKS FOREMAN <br /> BUSINESS PHONE(28) 209-599-2151 BUSINESS PHONE(33) 209-599-2151 <br /> 24-HOUR PHONE(29) 209-599-2133 24-HOUR PHONE(34) 209-599-3267 <br /> PAGER#(30) 209-236-4237 PAGER#(35) 209-599-4235 <br /> EXTREMELY HAZARDOUS SUBSTANCES (EHS) <br /> ON-SITE EHS (36) NO 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) TED JOHNSTON <br /> TAME OF OWNER/OPERATOR(39) TED JOHNSTON DATE(40) <br /> DATE REC'D: 1/16/04 <br />