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BUSINESS OWNER/OPERATOR IDENTIFICATION FORM 11 Account #: 5175 <br />I. IDENTIFICATION <br />SINESS NAME (4) CALIFORNIA WATER SVC - 21-01 BUSINESS PHONE (5) 1209-464-8311 <br />SITE ADDRESS (6) <br />CITY <br />DUN & <br />BRADSTREET <br />OPERATOR <br />NAME <br />13115 ❑ SANGUINETTI LN <br />Street No. Direction Street Name Street Type Apt/Bldg/Suite <br />(7) ISTOCKTON STATE (8) CA ZIP (9) F95205 <br />(10) 104-741-7241 SIC CODE (4 DIGIT #) (11) 14941 <br />(12)1ROSS MOILAN <br />OPERATOR PHONE (13)1209-464-8311 <br />II. BUSINESS OWNER <br />OWNER NAME (14) CALIFORNIA WATER SVC CO OWNER PHONE (15) 1800-750-8200 <br />OWNER MAILING ADDRESS (16) <br />(If different from site address) <br />1720 N FIRST ST <br />CITY (17) ISAN JOSE I STATE (18) ICA I ZIP (19) 195112 <br />III. ENVIRONMENTAL CONTACT <br />CONTACT NAME (20) ROSS MOILAN CONTACT PHONE (21) 209-464-8311 <br />MAILING ADDRESS (22) <br />iifferent from business <br />_,ling address) <br />Street No. Direction Street Name Street T e Apt/Bldg/Suite <br />CITY (23) STATE (24) ZIP (25) <br />Primary IV. EMERGENCY CONTACTS Secondary <br />NAME (26) IROSS MOILAN <br />TITLE (27) <br />ASSISTANCE DISTRICT MANAGER <br />BUSINESS PHONE (28) 209-464-8311 <br />24-HOUR PHONE (29) 209-464-8311 <br />PAGER # (30) IN/A <br />NAME (3 1) IERIC MAR <br />TITLE (32) IPROD SUPT <br />BUSINESS PHONE (33) 1209-464-8311 <br />24-HOUR PHONE (34) 1209-464-8311 <br />PAGER # (35) N/A <br />EXTREMELY HAZARDOUS SUBSTANCES (EHS) <br />ON-SITE EHS (36) NO I 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) <br />ROSS MOILAN <br />INAME OF OWNER/OPERATOR (39) ROSS MOILAN DATE (40) <br />DATE REC' D: 1/ 5 / 0 6 <br />