Laserfiche WebLink
FIED PROGRAM CONSOLIDATED FORM <br /> FACILITY INFORMATION <br /> BUSINESS OWNER/OPERATOR IDENTIFICATION <br /> Modification Date:05/24/2011 <br /> Last Website Update: 01/07/2008 Page_ of <br /> I. IDENTIFICATION <br /> FACILITY ID# 968 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 /> MANTECA EQUIPMENT RENTAL 209-239.3507 <br /> BUSINESS SITE ADDRESS 103 BUSINESS FAX <br /> 616 S MAIN ST Not Collected <br /> BUSINESS SITE CITY 104 ZIPCODE 105 COUNTY 108 <br /> MANTECA CA 95337 SAN JOAQUIN <br /> DUN&BRADSTREET 106 PRIMARY SIC 107 PRIMARY NAICS 107 <br /> 19-070-1938 1223 Not Collected <br /> BUSINESS MAILING ADDRESS 108 <br /> BUSINESS MAILING CITY 108t STATE 108c ZIP CODE 108d <br /> BUSINESS OPERATOR NAME 109 BUSINESS OPERATOR PHONE 110 <br /> JIM SALMON 209.239-7736 <br /> 11. BUSINESS OWNER <br /> OWNER NAME(14) III 1 OWNER PHONE(15) 112 <br /> MANTECA EQUIP RENTAL 209-239-3507 <br /> OWNER MAILING ADDRESS 113 <br /> 616 S.MAIN ST. <br /> OWNER MAILING CITY 114 STATE 11 ZIPCODE 116 <br /> MANTECA CA 95337 <br /> III. ENVIRONMENTAL CONTACT <br /> CONTACT NAME 117 1 CONTACT PHONE 118 <br /> JAMES SALMON 209-239-3507 <br /> CONTACT MAILING ADDRESS 119 CONTACT EMAIL 119 <br /> 616 S MAIN ST calisalmon@yahooxom <br /> CONTACT MAILING CITY 120 STATE 121 ZIP CODE 122 <br /> MANTECA CA 95337 <br /> IV. EMERGENCY CONTACTS <br /> NAME 123 NAME 128 <br /> JAMES SALMON DONALD SALMON <br /> TITLE 124 TITLE 129 <br /> PRES BOARD MEMBER <br /> BUSINESS PHONE 209-239-3507 125 BUSINESS PHONE 209-239-3507 130 <br /> 24-HOUR PHONE 209 824-4412 126 24-HOUR PHONE 209-824-4412 131 <br /> PAGER/CELL# N/A 127 PAGER/CELL# N/A 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,1 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 infornaiton submitted and <br /> believe the information is true,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 TITLEOFSIGNER 137 <br /> UPCF Rev. 12/2007/ <br />