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Am NIFIED PROGRAM CONSOLIDATED FO FACILITY INFORMATION BUSINESS OWNER/OPERATOR IDENTIFICATION Modification Date: 05/13/2009 Last Website Update: 5/13/2009 Page _ of I. IDENTIFICATION FACILITY ID# 13864 I 1 BEGINNING DATE N/A 100 ENDING DATE N/A 101 BUSINESS NAME (Same as FACILITY NAME or DBA - Doing Business As) 3 BUSINESS PHONE 102 THE WINE GROUP 209-2342452 10 BUSINESS SITE ADDRESS 103 BUSINESS FAX 1111 RUNWAY DR #5 Not Collected BUSINESS SITE CITY 104 ZIPCODE 105 COUNTY 108 STOCKTON CA 95206 SAN JOAQUIN DUN & BRADSTREET 106 PRIMARY SIC 107 PRIMARY NAICS 107a 064307671 2064 Not Collected BUSINESS MAILING ADDRESS 108a 17000 E HWY 120 RD-- - BUSINESS MAILING CITY 108 STATE 108c ZIP CODE 108d RIPON CA 95366 BUSINESS OPERATOR NAME 109 BUSINESS OPERATOR PHONE 110 THE WINE GROUP 209.234-2542 •'•' IL BUSINESS OWNER -- OWNER NAME (14) 111 OWNER PHONE (15) ----- -112 THE WINE GROUP 209-599-4111,;•, I OWNER MAILING ADDRESS 113 4596 S. TRACY BLVD. OWNER MAILING CITY 114 STATE 115 ZIP CODE ----116 TRACY CA 95377 III. ENVIRONMENTAL CONTACT CONTACT NAME 117 CONTACT PHONE 1.18 SUE GIAMPIETRO 1 559-528.3036 EX24 CONTACT MAILING ADDRESS 119 CONTACT EMAIL 119a 1111 S RUNWAY DR steve.ladonga@thewinegroup.com CONTACT MAILING CITY 120 STATE 121 ZIP CODE 122 STOCKTON CA 95206 IV. EMERGENCY CONTACTS NAME 123 NAME 128 STEVE LADONGA ROCKY GRAZIANO TITLE 124 TITLE '129 SUPERVISOR MANAGER ... BUSINESS PHONE 209-323-7242 125 BUSINESS PHONE 209-599-0422 130 24-HOUR PHONE 209.9546751 126 24-HOUR PHONE 209449-3116 131. PAGER# N/A 127 PAGER# N/A .. 132 ADDITIONAL LOCALLY COLLECTED INFORMATION: 133 COMPLETE PAGE 2 OF BUSINESS OWNER/OPERATOR IDENTIFICATION 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 established processes on the Administerting Agency's HMMP Compliance Website that 1 have personally examined and am familiar with the informaiton submitted and believe the information is tme, accurate, and complete. SIGNATURE OF OWNER/OPERATOR OR DESIGNATED REPRESENTATIVE I DATE 134 1 NAME OF DOCUMENT PREPARER 135 NAME OF SIGNER (print) 136 rTLE OF SIGNER 137 UPCF (Rev. 12/2007)