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r JAN 13 2003 <br /> BUSINESS OWNER/OPERATOR IDENTIFICATION FORM Account#: 418 <br /> I. IDENTIFICATION <br /> BUSINESS NAME (4) EAST BAY MUNICIPAL UTILITY BUSINESS PHONE(5) <br /> DIST - STOCKTON CENTER 209-946-8000 <br /> SITE ADDRESS (6) 1804 W❑ MAIN ST <br /> Street No. Direction Street Name Street T e A t/Blde/Suite <br /> CITY (7) STOCKTON STATE(8) CA ZIP(9) 95203 <br /> DUN& (10) SIC SICCODE(4DIGIT#)(11) <br /> BRADSTREET 4941 <br /> OPERATOR (I2) EAST BAY MUNICIPAL OPERATOR PHONE(13) <br /> NAME JUTILITY DIST 209-946-8000 <br /> II. BUSINESS OWNER <br /> OWNERNAME(14) EAST BAY MUNICIPAL OWNER PHONE(15) 510-835-3000 <br /> UTILITY DIST <br /> OWNER MAILING ADDRESS(16) P O. BOX 24055 <br /> (If different from site address) <br /> CITY(17) OAKLAND STATE(18) CA ZIP(19) 94623-1055 <br /> III. ENVIRONMENTAL CONTACT <br /> CONTACT NAME(20) DIANE HINSON CONTACT PHONE(2 1) 209-946-8043 <br /> MAILING ADDRESS (22) <br /> (If different from business 1804 F]IMAIN S T <br /> mailing address) <br /> Street No. Direction Street Name Street Type A t/Bldo/Suite <br /> CITY(23) <br /> FTOCKTON STATE(24) F <br /> ZIP(25) 95203 <br /> 99�— :1 <br /> Primary IV. EMERGENCY CONTACTS Second <br /> NAME(26) NAME(3 1)M L YOUNG VINCE DOOLEY <br /> TITLE(27) TITLE(32) <br /> ASST SUPT MAINT SUPVR <br /> BUSINESS PHONE(28) 209-946-8009 BUSINESS PHONE(33) 209-946-8007 <br /> 24-HOUR PHONE(29) 209-946-8000 24-HOUR PHONE(34) 209-946-8000 <br /> PAGER#(30) 209-540-9098 PAGER#(35) 209-540-9095 <br /> EXTREMELY HAZARDOUS SUBSTANCES (EHS) <br /> ON-SITE EHS (36) N O 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) DIANE HINSON, ENV HEALTH & SAFETY SPECIALIST <br /> NAME OF OWNER/OPERATOR(39) EAST BAY MUNICIPAL DATE(40) <br /> UTILITY DIST <br /> DATE REC'D: 1/13103 <br />