Laserfiche WebLink
UNIDOCS <br /> FACILITY INFORMATION <br /> BUSINESS OWNER/OPERATOR IDENTIFICATION <br /> I. IDENTIFICATION <br /> FACILITY ID# BEGINNING DATE 100 I ENDING DATE 101. <br /> (Agency Use Only) <br /> BUSINESS NAME(Same as Facility Name or DBA-Doing Business As) 3. BUSINESS PHONE 102. <br /> S-Mart #655 209 339-7170 <br /> BUSINESS SITE ADDRESS 103. BUSINESS FAX 1021, <br /> 530 West Lodi Avenue (209) 339-7177 <br /> BUSINESS SITE CITY 104. ZIP CODE 105. COUNTY 109. <br /> Lodi CA 95240 San Joaquin <br /> DUN&BRADSTREET 1m. PRIMARY SIC 107. PRIMARY NAICS 107a. <br /> 007874480 5411 <br /> BUSINESS MAILING ADDRESS m9.. <br /> 1800 Standiford Ave <br /> BUSINESS MAILING CITY man. STATE 108x. ZIP CODE load. <br /> Modesto CA 95350 <br /> BUSINESS OPERATOR NAME 109. BUSINESS OPERATOR PHONE 110. <br /> Save Mart Supermarkets 209 577-1600 <br /> II. BUSINESS OWNER <br /> OWNER NAME 111. OWNER PHONE 112. <br /> Save Mart Supermarkets 209 577-1600 <br /> OWNER MAILING ADDRESS 113. <br /> 1800 Standiford Ave <br /> OWNER MAILING CITY 114. 1 STATE 115. ZIP CODE Ila. <br /> Modesto CA 95350 <br /> III. ENVIRONMENTAL CONTACT <br /> CONTACT NAME 117. CONTACT PHONE 119. <br /> Sherry Aebersold 209 548-6569 <br /> CONTACT MAILING ADDRESS 119. CONTACT EMAIL 119.. <br /> 1800 Standiford Avenue seebersold@savemart.com <br /> CONTACT MAILING CITY 120. STATE 121, ZIP CODE 122. <br /> Modesto CA 95350 <br /> -PRIMARY- IV. EMERGENCY CONTACTS -SECONDARY- <br /> NAME 123. NAME 128. <br /> Michael Kant DennyWraske <br /> TITLE 124. TITLE 129. <br /> Store Manager Sr. Director of Operations <br /> BUSINESS PHONE 125. BUSINESS PHONE - 130. <br /> 209 339-7170 209 548-6608 <br /> 24-HOUR PHONE <br /> 126. 24-HOUR PHONE 131. <br /> 209 470-8496 209 484-2333 <br /> PAGER# 127. PAGER# 132. <br /> N/A N/A <br /> ADDITIONAL LOCALLY COLLECTED INFORMATION: 133. <br /> Certification: Based on my inquiry of those individuals responsible for obtaining the information,1 certify under penalty of law that I have personally examined mad <br /> am familiar with the information submitted and believe the information is true,accurate,and complete. <br /> SIG A RE OF ER/OPERATOR OR DESIGNATED REPRESENTATIVE DATE 134. 1 NAME OF DOCUMENT PREPARER 135. <br /> 3. ISZD11 IBillieGravano <br /> N E S (p' t 136. TITLE OF SIGNER 137, <br /> S r Aebers Id Dire&me ()f Compliance/ISO <br /> S-Mart#655 Page 2 of 18 March 2011 <br />