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Account#: 487 <br /> I. IDENTIFICATION <br /> BUSINESS NAME (4) JSG TRUCKING CO BUSINESS PHONE(5) 209-368-8815 <br /> SITE ADDRESS (6) 19400 N❑ HWY 99 <br /> Street No. Direction Street Name Street Type A t/Bld Suite <br /> CITY (7) ACAMPO STATE(8) CA ZIP(9) 95220 <br /> DUN& (10) 04-120-3597 SIC CODE(4 DIGIT#)(11) 4212 <br /> BRADSTREET <br /> OPERATOR (12)JM GIAMMONA OPERATOR PHONE(13) 209-368-8815 <br /> NAME <br /> II.BUSINESS OWNER <br /> OWNER NAME(14) JM GIAMMONA OWNER PHONE(15) 209-368-8815 <br /> OWNER MAILING ADDRESS(16) N/A <br /> (If different from site address) <br /> CITY(17) N/A STATE(18) N/A ZIP(19) N/A <br /> III. ENVIRONMENTAL CONTACT <br /> CONTACT NAME(20) JOE HETU CONTACT PHONE(21) 209-368-8815 <br /> MAILING ADDRESS (22) <br /> (If different from business N/A ❑ N/A N/A <br /> mailing address) Street No. Direction Street Name Street Type A tBld Suite <br /> CITY(23) F <br /> STATE(24) N/A ZIP(25) N/A <br /> Primary IV. EMERGENCY CONTACTS Secondary <br /> NAME(26) �JM GIAMMONA NAME(31) JOE HETU <br /> TITLE(27) PRESIDENT TITLE(32) SAFETY MANAGER <br /> BUSINESS PHONE(28) 209-368-8815 BUSINESS PHONE(33) 209-368-8815 <br /> 24-HOUR PHONE(29) 209-759-9199 24-HOUR PHONE(34) 209-482-6141 <br /> PAGER#(30) 209-993-0187 PAGER#(35) <br /> EXTREMELY HAZARDOUS SUBSTANCES (EHS) <br /> ON-SITE EHS (36) NO 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) JM GIAMMONA <br /> NAME OF OWNER/OPERATOR(39) JM GIAMMONA DATE(40) <br /> DATE REC'D: 4/19/06 <br />