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UNIFIED PROGRAM CONSOLIDATED FORM D <br /> FAr1I.ITV INFORMATION Lr <br /> BUSINESS OWNER/OPERATOR IDENTIFICATION <br /> Last Website Update: ® Page of <br /> I. IDENTIFICATION <br /> FACILITY TD# 9457 1 1 RRGINNING DATF N/A 100 ENDING DATE N/A 101 <br /> BUSINESS NAME(Same as FACILITY NAME or DBA-Doine Business As) 3 BUSINESS PHONE 102 <br /> LODI AIRPORT 209-369-9126 <br /> RT TSINF.SS STTF ADDRFSS 103 BUSINESS FAX <br /> 23987 N HWY 99 Not Collected <br /> BUSINESS SITE CITY 104 RIP CnD17, 105 COUNTY 108 <br /> ACAMPO CA 95220 SAN JOAOUIN <br /> DUN&BRADSTREET 106 PRIMARY SIC 107 PRIMARY NAICS 107 <br /> N/A 4581 Not Collected <br /> RTISTNFSS MATTING ADDRFSS IORa <br /> P.O.BOX 10 <br /> BUSINESS MAILING CITY 1081 STATE 10R ZIP CODE 108d <br /> ACAMPO CA 95220 <br /> BUSINESS OPERATOR NAME 109 BUSINESS OPERATOR PHONE 110 <br /> ROBERT KUPKA 209-369-9126 <br /> II. BUSINESS OWNER <br /> OWNERNAME(14) Ill nWNFRPHONF(15) 112 <br /> ROBERT KUPKA 209-369-9126 <br /> nWNFR MATLTNG ADDRFSS 113 <br /> OWNFR MAIL INn(.TTV 114 STATE 115 71P CDDF 116 <br /> III. ENVIRONMENTAL CONTACT <br /> CONTACT NAME 117 1 CONTACT PHONE 118 <br /> ROBERT KUPKA 209-369-9126 <br /> CONTACT MAILING ADDRESS 1 1 n CONTACT EMAIL 119a <br /> bkupka@sbcglobal.net <br /> CONTACT MAILING CITY 120 STATE 121 FTP MDF 122 <br /> IV. EMERGENCY CONTACTS <br /> NAME ROBERT KUPKA 123 NAME JOHN KUPKA 128 <br /> TITLE OWNER 124 TITLE RELATIVE 129 <br /> BUSINESS PHONE 209-369-9126 125 BUSINESS PHONE 530-677-2411 130 <br /> 24-HOUR PHONE 209-334-6719 126 94-MOT TR PHONF 530-677-2411 131 <br /> PAGFR/nFT.T.* N/A 127 PAnFR/4717.1.1.# 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,I certify under penalty of law by signing below or certifying by the <br /> established processes on the Administening Agency's HMMP Compliance Website that I have personally examined and am familiar with the infovnaiton submitted and <br /> SIGNATURE OF OWNER/OPERATOR OR DESIGNATED REPRESENTATIVE I DATE 114 1 NAME OF DOCUMENT PREPARER 135 <br />