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r <br /> J c i VIED PROGRAM CONSOLIDATED FOY <br /> 1.� FACILITY INFORMATION <br /> BUSINESS OWNER/OPERATOR IDENTIFICATION <br /> Page_I—of-1_ <br /> I.IDENTIFICATION <br /> FACILITY ID# JFJ � 1510181411 1BEGINNINGDATE100 ENDING DATE 101 <br /> 0 0 0 <br /> 05-18-09 05-18-10 <br /> BUSINESS NAME(same 8s FAc1LrrY NAND or DBA-Doing ausims As) 3 BUSINESS PHONE 102 <br /> CEMEX Construction Materials Pacific LLC 209-982-0555 <br /> BUSINESS SITE ADDRESS 103 BUSINESS FAX 1028 <br /> 889 East Roth Road 209-983-4012 <br /> BUSINESS SITE CITY 104 ZIP CODE 105 COUNTY los <br /> ch Camp <br /> CA 95231 s"jmgwn <br /> DUN&BRADSTREET 1D6 PRIMARY SIC 107 PRIMARY NAICS lore <br /> 18-984-0945 3273 <br /> BUSINESS MAILING ADDRESS 1093 <br /> 5180 Golden Foothill Parkway <br /> BUSINESS MAILING CITY lose STATE107 ZIP CODE load <br /> El Dorado Hills CA 95762 <br /> BUSINESS OPERATOR NAME 109 BUSINESS OPERATOR PHONE 110 <br /> II.BUSINESS OWNER <br /> OWNER NAME 111 OWNER PHONE 112 <br /> CEMEX—Attn: Louis B. Schipper 916-941-2920 <br /> OWNER MAILING ADDRESS 113 <br /> 5180 Golden Foothill Parkway <br /> OWNER MAILING CITY 114 STATE 115 1 ZIP CODE 116 <br /> El Dorado Hills CA 95762 <br /> III.ENVIRONMENTAL CONTACT <br /> CONTACT NAME 117 CONTACT PHONE 116 <br /> Louis B. Schivver 916-941-2920 <br /> CONTACT MAILING ADDRESS 119 CONTACT EMAIL 1198 <br /> 5180 Golden Foothill Parkwayh " " <br /> CONTACT MAILING CITY 120 STATE 121 ZIP CODE 122 <br /> El Dorado Hills CA 95762 <br /> -PRIMARY- IV.EMERGENCY CONTACTS -SECONDARY- <br /> NAME 123 NAME 126 <br /> Steve Holland HgM Ambrosini <br /> TITLE 124 TITLE 129 <br /> Area Manager Overations Mana er <br /> 13USINESS PHONE 125 BUSINESS PHONE 13o <br /> 209-524-6322 559-277-2266 xt. 107 <br /> 24-HOUR PHONE 126 24-HOUR PHONE 131 <br /> 209-652-3968 559-217-8626 <br /> PAGER# 127 PAGER# 132 <br /> 133 <br /> ADDITIONAL LOCALLY COLLECTED INFORMATION: <br /> Certification: Based on my inquiry of those individuals responsible for obtaining the information,I certify under penalty of law that I have personally examined and <br /> am familiar with the information submitted and believe the information is true,accurate,and complete. <br /> SIGNATURE OF!7=DES ATEA REfRESE ATDATE i 34 NAME OF DOC INTENT PREPARER 135 <br /> ,4 A L405/18/09 Michelle K. Wesch <br /> NAME OF SIGNER(prim) 136 TITLE OF SIGNER 137 <br /> Michelle K. Wesch Environmental Assistant <br /> UPCF(Rev.1212067) <br />