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BUSINESS OWNER/OPERATOk IDENTIFICATION FO Account#: 2876 <br /> ) , <br /> 1. IDENTIFICATION <br /> BUSINESS NAME (4) TED'S WELDING & REPAIR BUSINESS PHONE(5) 209-368-9864 <br /> SITE ADDRESS (6) 8932 IFY 12 <br /> Street No. Direction Street Name Street Type An/Bldg/Suite <br /> CITY (7) VICTOR STATE(8) CA ZIP(9) 95253 <br /> DUN& (10) 55-569-2672 SIC CODE(4 DIGIT#) (11) 2876 <br /> BRADSTREET <br /> OPERATOR (12) BILL (GEORGE) BRAUN OPERATOR PHONE(13) 209-365-9416 <br /> NAME <br /> II.BUSINESS OWNER <br /> OWNER NAME(14) BILL (GEORGE) BRAUN OWNER PHONE(15) 209-365-9416 <br /> OWNER MAILING ADDRESS(16) P O. BOX 611 <br /> (If different from site address) <br /> CITY(17) VICTOR STATE(18) CA ZIP(19) 95253 <br /> III. ENVIRONMENTAL CONTACT <br /> CONTACT NAME(20) BILL BRAUN CONTACT PHONE(21) 209-368-9864 R <br /> 209-365-9416 <br /> MAU-ING ADDRESS (22) <br /> (If different from business 11798 IF <br /> BENDORF RD <br /> mailing address) <br /> Street No. Direction Street Name Street Type A t/Bld Suite <br /> CITY(23) MPO STATE(24) ZIP(25) <br /> 95220 <br /> FACACA <br /> Primary IV. EMERGENCY CONTACTS Secondary <br /> NAME(26) BILL BRAUN NAME(3 1) NONE <br /> TITLE(27) OWNER TITLE(32) N/A <br /> BUSINESS PHONE(28) 209-368-9864 BUSINESS PHONE(33) N/A <br /> 24-HOUR PHONE(29) 209-365-9416 HM 24-HOUR PHONE(34) N/A <br /> PAGER#(30) 209-603-8979 CELL 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) BILL (GEORGE) BRAUN <br /> NAME OF OWNER/OPERATOR(39) BILL ( GEORGE) BRAUN DATE(40) 6/27/2001 <br /> DATE REC'D: 1/28/08 <br />