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Bi SINESS OWNER/OPERATOk llENTIFICATION FORM Account#: 12495 <br /> I. IDENTIFICATION <br /> BUSINESS NAME (4) BAL USC BUSINESS PHONE(5) 209-932-0606 <br /> SITE ADDRESS (6) 4236 S❑ HWY 99 FRONTAGE RD <br /> Street No. Direction Street Name Street Type A t/Bld Suite <br /> CITY (7) STOCKTON STATE(8) CA ZIP(9) 95215 <br /> DUN & (10)NONE SIC CODE(4 DIGIT#) (11) 5112 <br /> BRADSTREET <br /> OPERATOR (12) RON BARBER OPERATOR PHONE(13) 209-932-0606 <br /> NAME <br /> II. BUSINESS OWNER <br /> OWNER NAME(14) FON BARBER OWNER PHONE(15) 209-932-0606 <br /> OWNER MAILING ADDRESS(16) 10411 SMALL RD. <br /> (If different from site address) <br /> CITY (17) MANTECA STATE(18) CA ZIP(19) 95336 <br /> III. ENVIRONMENTAL CONTACT <br /> CONTACT NAME(20) FON BARBER CONTACT PHONE(21) 209-932-0606 <br /> MAILING ADDRESS(22) <br /> ❑ <br /> (If different from business <br /> mailing address) Street No. Direction Street NameStreet Type A VBId Suite <br /> CITY(23) F :1 STATE(24) <br /> [::] <br /> ZIP(25) <br /> Primary IV. EMERGENCY CONTACTS Secondary <br /> NAME(26) NAME(3 1) <br /> JOSEPH BLACKWELL FRON BARBER <br /> TITLE(27) GENERAL MANAGER OF TITLE(32) PRESIDENT <br /> OPERATIONS <br /> BUSINESS PHONE(28) 209-932-0606 BUSINESS PHONE(33) 209-932-0606 <br /> 24-HOUR PHONE(29) 209-993-1639 24-HOUR PHONE(34) 209-969-2199 <br /> PAGER#(30) N/A PAGER#(35) N/A <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) JOSEPH BLACKWELL <br /> NAME OF OWNER/OPERATOR(39) IRON BARBER DATE(40) <br /> DATE REC'D: 11/14/07 <br />