Laserfiche WebLink
UNIDOCS <br /> FACILITY INFORMATION <br /> BUSINESS OWNER/OPERATOR IDENTIFICATION <br /> I. IDENTIFICATION <br /> FACILITY ID# — 1- BEGINNING DATE IW_ ENDING DATE 10I_ <br /> (Agency Use Only) — <br /> BUSINESS NAME(Same as Facility Name or DBA–Doing Business As) 3. BUSINESS PHONE 102_ <br /> S-Mart#209 209 334-6853 <br /> BUSINESS SITE ADDRESS 103, BUSINESS FAX 102., <br /> 610 W. Kettleman Ln. 209 334-1254 <br /> BUSINESS SITE CITY 104- ZIP CODE 105- COUNTY 108- <br /> Lodi CA 95240 San Joaquin <br /> DUN&BRADSTREET 106. PRIMARY SIC 107, PRIMARY NAICS 107e. <br /> 007874480 5411 <br /> BUSINESS MAILING ADDRESS 108.. <br /> 1800 Standiford Ave. <br /> BUSINESS MAILING CITY test, I STATE 10sa ZIP CODE mad. <br /> Modesto CA 95350 <br /> BUSINESS OPERATOR NAME 109. BUSINESS OPERATOR PHONE Ho_ <br /> Save Mart Supermarkets 209 577-1600 <br /> II. BUSINESS OWNER <br /> OWNER NAME OWNERPHONE 112. <br /> Save Mart Supermarkets 209 577-1600 <br /> OWNER MAILING ADDRESS 113. <br /> 1800 Standiford Ave. <br /> OWNER MAILING CITY 114, 1 STATE 1 i5. ZIP CODE 116. <br /> Modesto CA 95350 <br /> III. ENVIRONMENTAL CONTACT <br /> CONTACT NAME 111- CONTACTPHONE its, <br /> Sherry Aebersold 209 548-6569 <br /> CONTACT MAILING ADDRESS 119, CONTACT EMAIL 11%, <br /> 1800 Standiford Ave. saebersold@savemart.com <br /> CONTACT MAILING CITY 120 1 STATE 121.1 ZIP CODE 122. <br /> Modesto CA 95350 <br /> -PRIMARY- IV. EMERGENCY CONTACTS -SECONDARY- <br /> NAME 123, NAME 128. <br /> John Martin Dave Melendez <br /> TITLE 124. TITLE 129. <br /> Store Manager Senior Director of Operations <br /> BUSINESS PHONE 125. BUSINESS PHONE 110 <br /> 209 334-6853 209 574-6299 ext. 5336 <br /> 24-HOUR PHONE 126- 24-HOUR PHONE 131. <br /> 916 761-1992 209 484-2331 <br /> PAGER# 127. PAGER# 132. <br /> N/A N/A <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 <br /> am familiar with the information submitted and believe the information is true,accurate,and complete. <br /> SIG URE O WNER/OPE T OR DESIGNATED REPRESENTATIVE DATE 134. NAME OF DOCUMENT PREPARER 135. <br /> 7. 14. 7-01 ikki Boru <br /> VM IG R( riot) 136. TITLE OF SIGNER 137er Aebersol Director of Compliance/ISO <br /> S-Mart#209 Page 2 of 20 July 2012 <br />