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*NIFIED PROGRAM CONSOLIDATED F4M <br /> FAC11dTV INFORMATTON <br /> BUSINESS OWNER/OPERATOR IDENTIFICATION <br /> Last Website Update: Page of <br /> I. IDENTIFICATION <br /> FACTT.TTY TD* 12529 1 RFGTNNING DATF NSA 100 ENDING DATE NSA 101 <br /> BUSINESS NAME(Same as FACILITY NAME or DBA-Doine Business As) 3 BUSINESS PHONE 102 <br /> ULLOA'S TOW&AUTO REPAIR 209-943-0588 1021 <br /> RTTCTNFRR SITF.ADDRF9,9 103 BUSINESS FAX <br /> 620 S WILSON WAY STE C Not Collected <br /> BUSINESS SITE CITY 104 71P CODF. 105 COUNTY 108 <br /> STOCKTON CA 95205 SAN JOAQUIN <br /> DUN&BRADSTREET 106 PRIMARY SIC 107 PRIMARY NAILS 107 <br /> Not Collected <br /> RTTSTNF.RR MATTING ADDRFCS IOR <br /> BUSINESS MAILING CITY 1081 STATE 10R ZIP CODE 108d <br /> BUSINESS OPERATOR NAME 109 BUSINESS OPERATOR PHONE 110 <br /> BRENDA NARANJO 209-943-0588 <br /> II. BUSINESS OWNER <br /> OWNER NAME(14) 111 1 OWNPR PHONE 115) 112 <br /> ULLOA'S TOW&AUTO REPAIR 209-943-0588 <br /> OWNER MATT TNG ADDRESS 113 <br /> OWNPR MATT TNG CITY 114 STATE 115 ZIP CODE. 116 <br /> III. ENVIRONMENTAL CONTACT <br /> CONTACTNAME 117 1 CONTACT PHONE 118 <br /> BRENDA NARANJO 209-943-0588 <br /> CONTACT MAILING ADDRESS "o CONTACT EMAIL 119P <br /> CONTACT MAILING CITY 120 STATE 121 7TP CODE 122 <br /> IV. EMERGENCY CONTACTS <br /> NAME 123 NAME 128 <br /> TITLE 124 TITLE 129 <br /> BUSINESS PHONE 125 BUSINESS PHONE 130 <br /> 24-HOUR PHONE 126 94-14()TTR PHONE. 131 <br /> PAGFR/CFT T.d 127 1 PAGRR/CRT J.;1 132 <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 Administerting Agency's HMMP Compliance Website that I have personally examined and am familiar with the infomraiton submitted and <br /> SIGNATURE OF OWNER/OPERATOR OR DESIGNATED REPRESENTATIVE I DATE 114 1 NAME OF DOCUMENT PREPARER 135 <br />