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r UNIFIED PROGRAM CONSOLIDATED FORM <br /> FACILITY INFORMATION <br /> BUSINESS OWNER/OPERATOR IDENTIFICATION <br /> Page 1 of I <br /> I.IDENTIFICATION <br /> FACILITY ID# BEGINNING DATE <br /> 1 100 ENDING DATE lal <br /> FA0007213 <br /> BUSINESS NAME(S..FACILITY NAME or DBA-Doing Busuass As) 3 BUSINESS PHONE lox <br /> METALSA STRUCTURAL PRODUCTS INC 209 983-6100 <br /> BUSINESS SITE ADDRESS 103 <br /> 1550 INDUSTRIAL DR <br /> CITY <br /> 108 ZIP CODE I05 <br /> STOCKTON CA 95206-3929 <br /> DUN&BRADSTREET <br /> IOfi SIC CODE(4 digit#) 103 <br /> 013322433 3714 <br /> COUNTY <br /> 108 <br /> SAN JOA UIN COUNTY <br /> BUSINESS OPERATOR NAME Iaq BUSINESS OPERATOR PHONE IIO <br /> (270)769-7000 <br /> II.BUSINESS OWNER <br /> OWNER NAME <br /> 111 OWNER PHONE 112 <br /> OWNER MAILING ADDRESS <br /> 113 <br /> 750 N BLACK BRANCH RD <br /> CITY Ila STATE 115 I ZIP CODE 116 <br /> ELIZABETHTOWN I KY 427014503 <br /> III.ENVIRONMENTAL CONTACT <br /> CON I ACI NAME ❑7 COMACTPHONIE Ila <br /> LISA ROSA (209)983-6106 <br /> CONTACT MAILING ADDRESS <br /> IN <br /> CITY 120 STATE 121 I ZIP CODE 123 <br /> -PRIMARY- IV.EMERGENCY CONTACTS -SECONDARY- <br /> NAME 133 NAME Ila <br /> GARY LARSON RAUL RAGUNTON <br /> TITLE 134 TITLE 139 <br /> FACILITIES COORDIATOR ENGINEERING MANAGER <br /> BUSINESS PHONE Dy BUSINESS PHONE 130 <br /> 209 983-6108 209 983-6102 <br /> 24-HOUR PHONE 126 24-HOUR PHONE 131 <br /> 209 321-5579 209 603-4968 <br /> PAGER# 123 PAGER# 132 <br /> 209 6034968 209 603-4968 <br /> ADDITIONAL LOCALLY COLLECTED INFORMATION: 133 <br /> Certification: Based on my inquiry of those individuals responsible for obtaining the information,I certify under penalty of law that I have personally examined and am familiar with <br /> the information submitted and believe the information is true,accurate,and complete. <br /> SIGNATURE OF OWNER/OPERATOR OR DESIGNATED REPRESENTATIVE DATE 131 1 NAMEOFDOCUMENTPREPARAR 135 <br /> NAME OF SIGNER(pin) 136 TITLE OF SIGNER 137 <br /> UPCF( 1/99 revised) <br />