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iICITvE4S nWNER/OPERA EP'IWICA7ION FORM �' FAccount#: G'1✓N <br /> I. IDENTIFICATION <br /> BUSINESS NAME (4) COPPER ENTERPRISES INC BUSINESS PHONE(5) 209-727-9770 <br /> SITE ADDRESS (6) 12470 LOCKS RD BLDG 100 <br /> Street No. Direction Street Name Street T e A t/Bld Suite <br /> CITY (7) LOCKEFORD STATE(8)FCA ZIP(9) 95237 <br /> DUN& (10) 02-013-6094 SIC CODE(4 DIGIT#)(I1) 8744 <br /> BRADSTREET <br /> OPERATOR (12) DON LITCHFIELD OPERATOR PHONE(13) 209-727-9770 <br /> NAME <br /> II. BUSINESS OWNER <br /> OWNER NAME(14) DON LITCHFIELD OWNER PHONE(15) 209-727-9770 <br /> OWNER MAILING ADDRESS (16) 12470 LOCKE ROAD, BLDG. 100 <br /> (If different from site address) <br /> CITY(17) LOCKEFORD STATE(18) CA ZIP(19) 95237 <br /> III. ENVIRONMENTAL CONTACT <br /> CONTACT NAME(20) DON LITCHFIELD CONTACT PHONE(21) 209.727.9770 <br /> MAILING ADDRESS(22) ❑ <br /> (If different from business <br /> mailing address) <br /> Street No. Direction I <br /> Street NameSVeetType Apt/Bldg/Suite <br /> CITY(23) 1 STATE(24) E] ZIP(25) <br /> Primary IV. EMERGENCY CONTACTS Secondary <br /> NAME(26) DON LITCHFIELD NAME(3 1) KARYN LITCHFIELD <br /> TITLE(27) VP TITLE(32) FRES <br /> BUSINESS PHONE(28) 209-727-9770 BUSINESS PHONE(33) 209-727-9770 <br /> 24-HOUR PHONE(29) 209-993-0589 24-HOUR PHONE(34) 209-993-0590 <br /> PAGER#(30) 209-993-0589 PAGER#(35) 209-993-0590 <br /> EXTREMELY HAZARDOUS SUBSTANCES (EHS) <br /> ON-SITE EHS (36) j'E$ 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) DON LITCHFIELD <br /> NAME OF OWNER/OPERATOR(39) DON LITCHFIELD DATE(40) <br /> DATE REC'D: <br />