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U IIFIED PROGRAM CONSOLIDATED FORM <br /> FACILITY INFORMATION <br /> BUSINESS OWNER/OPERATOR IDENTIFICATION <br /> Modification Date:06/02/2010 <br /> Last Website Update: 02/12/2008 Page_ of <br /> I. IDENTIFICATION <br /> FACILITY ID# 9158 1 1 BEGINNING DATE N/A 100 ENDING DATE N/A 101 <br /> BUSINESS NAME(Same as FACILITY NAME or DBA-Doing Business As) 3 BUSINESS PHONE 102 <br /> COPPER ENTERPRISES INC(CLOSED) 209-727-9770 102.1 <br /> BUSINESS SITE ADDRESS 103 BUSINESS FAX <br /> 12470 E LOCKE RD BLDG Not Collected <br /> BUSINESS SITE CITY 104 ZIP CODE 105 COUNTY 108 <br /> LOCKEFORD CA 95237 SAN JOAQUIN <br /> DUN&BRADSTREET 106 PRIMARY SIC 107 PRIMARY NAICS 107 <br /> 02-013-6094 8744 Not Collected <br /> BUSINESS MAILING ADDRESS 108 <br /> P.O.BOX 70 <br /> BUSINESS MAILING CITY 108t STATE 108c ZIP CODE 108d <br /> FAIR OAKS CA 95629-0070 <br /> BUSINESS OPERATOR NAME 109 BUSINESS OPERATOR PHONE 110 <br /> DON LITCHFIELD 209-727-9770 <br /> II. BUSINESS OWNER <br /> OWNER NAME(14) 111 1 OWNER PHONE(15) 112 <br /> DON LITCHFIELD 209-727-9770 <br /> OWNER MAILING ADDRESS 113 <br /> 12470 LOCKE ROAD,BLDG.100 <br /> OWNER MAILING CITY 114 STATE I1 ZIP CODE 116 <br /> LOCKEFORD CA 95237 <br /> III. ENVIRONMENTAL CONTACT <br /> CONTACT NAME 117 1 CONTACT PHONE 118 <br /> DON LITCHFIELD 209-727.9770 <br /> CONTACT MAILING ADDRESS 119 CONTACT EMAIL 119 <br /> cudkl@aol.com <br /> CONTACT MAILING CITY 120 STATE 171P CODE 122 <br /> IV. EMERGENCY CONTACTS <br /> NAME DON LITCHFIELD 123 NAME KARYN LITCHFIELD 128 <br /> TITLE VP PRES 124 TITLE 129 <br /> BUSINESS PHONE 209-727-9770 125 BUSINESS PHONE 209-727-9770 130 <br /> 24-HOUR PHONE 209-993-0589 126 24-HOUR PHONE 209-993-0590 131 <br /> PAGER/CELL# 209-993-0589 127 PAGER/CELL# 209-993-0590 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 mfomamon is we,accurate,and complete. <br /> SIGNATURE OF OWNER/OPERATOR OR DESIGNATED REPRESENTATIVE DATE 134 1 NAME OF DOCUMENT PREPARER 135 <br /> NAME OF SIGNER(print) 136 TITLE OF SIGNER 137 <br /> UPCF Rev. 1212007 <br />