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• • RECEIVED 1 <br /> JAN - 4 2012 1 <br /> UNIFIED PROGRAM CONSOLIDATED FORM SAN JOAQUIN COUNTY <br /> FACILITY INFORMATION OFFICE OF EMERGENCY SERVIC 1 <br /> BUSINESS OWNER/OPERATOR IDENTIFICATION <br /> (12/22/2011 - 12:45:20 PM) <br /> Page of <br /> I. IDENTIFICATION <br /> FACILITY ID# 13542 I BEGINNINGDATE N/A 100 ENDINGDATE N/A 101 <br /> BUSINESS NAME(Same as FACILITY NAME or DBA-Doing Business As) 3 BUSINESS PHONE 102 <br /> HD SUPPLY DISTRIBUTION SERVICES CB0005 (209)234-8930 1 <br /> BUSINESS SITE ADDRESS 103 BUSINESS FAX 102a <br /> 2055 INDUSTRIAL DR Not Collected <br /> BUSINESS SITE CITY104 ZIP CODE 105 COUNTY 108 <br /> STOCKTON CA 95206 SAN JOAQUIN 1 <br /> DUN&BRADSTREET 106 PRIMARY SIC 107 PRIMARY NAICS 107a <br /> 02-022-2873 4225 Not Collected <br /> BUSINESS MAILING ADDRESS 108a 1 <br /> 501 W.CHURCH ST. <br /> BUSINESS MAILING CITY 108 STATE 108c ZIP CODE I08d <br /> ORLANDO FL 22385 <br /> BUSINESS OPERATOR NAME 109 BUSINESS OPERATOR PHONE 110 1 <br /> HD SUPPLY DISTRIBUTION SERVICES,LLC. (407)822-2385 <br /> H. BUSINESS OWNER <br /> OWNER NAME(14) I I I I OWNER PHONE(I5) 112 1 <br /> HD SUPPLY INC (770)852.9000 <br /> OWNER MAILING ADDRESS 113 <br /> 3100 CUMBERLAND BLVD,MS-1226 1 <br /> OWNER MAILING CITY 114 STATE 115 ZIP CODE 116 <br /> ATLANTA GA 30339 <br /> 111. ENVIRONMENTAL CONTACT <br /> CONTACT NAME 117 CONTACT PHONE 118 1 <br /> SHEILA WESTERVELD,MSE (407)822-2385 <br /> CONTACT MAILING ADDRESS 119 CONTACT EMAIL 119a <br /> 501 W CHURCH ST sheila.Westerveld@hdsupply.com 1 <br /> CONTACT MAILING CITY 120 STATE 121 ZIP CODE 122 <br /> ORLANDO FL 32805 <br /> IV. EMERGENCY CONTACTS 1 <br /> NAME FRANK POST 123 NAME HENRY MAGALLON 128 <br /> TITLE WAREHOUSE MANAGER 124 TITLE ASSISTANT WAREHOUSE 129 <br /> MANAGER 1 <br /> BUSINESS PHONE (209)234-8930 125 BUSINESS PHONE (209)234-8930 130 <br /> 24-HOUR PHONE (949)680-0689 126 24-HOUR PHONE (949)468-8193 131 <br /> PAGER/CELL# NA 127 PAGER/CELL# NA 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 cenify under penalty of law by signing below orcenifying by the <br /> established processes on the Adminutening Agency's HMMP Compliance Website that 1 have personally examined and am familiar with the inforramton illumined and <br /> believe the information is true,accurate,and cum tae. <br /> SIGNATURE OF OWNER/OPERATOR OR DESIGNATED REPRESENTATIVE DATE 134 NAME OF DOCUMENT PREPARER 135 <br /> Dmfs _ 01/01/2(12 ERM-West,Inc.-Eric Graham <br /> NAME OF SIGNER(print) �/' 136 TITLEOFSIGNER 137 , <br /> Sheila Westerveld Environmental,Health and Safety Mana <br /> q%CF(Rev.12/2007) <br /> 1 <br />