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FIED PROGRAM CONSOLIDATED FORM <br /> FACILITY INFORMATION <br /> BUSINESS OWNER/OPERATOR IDENTIFICATION <br /> Modification Date:01/12/2010 <br /> Last Website Update: 12/18/2008 Page_ of_ <br /> I. IDENTIFICATION <br /> FACILITY ID# 12065 I 1 BEGINNING DATE N/A 100 ENDING DATE 101 <br /> N/A <br /> BUSINESS NAME(Same as FACILITY NAME or DBA-Doing Business As) 3 BUSINESS PHONE 102 <br /> TWO RIVERS R.V.PARK 209-823.8434 <br /> BUSINESS SITE ADDRESS 103 BUSINESS FAX <br /> 31021 TWO RIVERS RD Not Collected <br /> BUSINESS SITE CITY 104 ZIP CODE 105 COUNTY 108 <br /> MANTECA CA 95337-9468 SAN JOAQUIN <br /> DUN&BRADSTREET 106 PRIMARY SIC 107 PRIMARY NAICS 107a <br /> 609984211 7033 Not Collected <br /> BUSINESS MAILING ADDRESS 108a <br /> P.O.BOX 1424 <br /> BUSINESS MAILING CITY 108STATE 108c ZIP CODE 108d <br /> MANTECA CA 95336 <br /> BUSINESS OPERATOR NAME 109 BUSINESS OPERATOR PHONE 110 <br /> GEORGE TURKMANY 209-823-8434 <br /> II. BUSINESS OWNER <br /> OWNER NAME(14) 111 OWNER PHONE(15) 112 <br /> GEORGE TURKMANY 209.823-8434 <br /> OWNER MAILING ADDRESS 113 <br /> 31021 TWO RIVERS RD. <br /> OWNER MAILING CITY 114 STATE 1I5 ZIP CODE 116 <br /> MANTECA CA 95337-9468 <br /> III. ENVIRONMENTAL CONTACT <br /> CONTACT NAME 117 CONTACT PHONE 118 <br /> GEORGE TURKMANY 209-914-6444 <br /> CONTACT MAILING ADDRESS 119 CONTACT EMAIL 119a <br /> 31021 TWO RIVERS RD gtallspice(Paol.com <br /> CONTACT MAILING CITY 120 STATE 121 ZIP CODE 122 <br /> MANTECA CA 95337-9468 <br /> IV. EMERGENCY CONTACTS <br /> NAME 123 NAME 128 <br /> RUTH LACELLE GEORGE TURKMANY <br /> TITLE 124 TITLE <br /> MANAGEMENT OWNER 129 <br /> BUSINESS PHONE 209-825-6962 - 125 BUSINESS PHONE 209-523-8434 130 <br /> 24-HOUR PHONE 126 24-HOUR PHONE 131 <br /> 209-825-6962 209.914-6444 <br /> PAGER/CELL# N/A 127 PAGER/CELL# <br /> N/A 132 <br /> ADDITIONAL LOCALLY COLLECTED INFORMATION: 133 <br /> COMPLETE PAGE 2 OF BUSINESS OWNER/OPERATOR IDENTIFICATION <br /> Cenificstion: 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 Administering Agency's HMMP Compliance Website that I have personally examined and sin familiar with the informaiton submitted and <br /> believe the information is We,accurate,and coin fete. <br /> SIGNATURE OFOWNER/OPERATOR OR DESIGNATED REPRESENTATIVE DATE 134 NAME OF DOCUMENT PREPARER 135 <br /> NAME OF SIGNER(print) 136 TITLE OF SIGNER 137 <br /> UPCF Rev.12YL <br />