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UNIFIED PROGRAM CONSOLIDATED FORM <br /> FACILITY INFORMATION <br /> BUSINESS OWNER/OPERATOR IDENTIFICATION <br /> i <br /> Pae of <br /> L::IDENTIFICATION ,', <br /> FACILITY ID# t. BEGINNING DATE 100 <br /> (Agency Use �OniyJ � ENDING DA"I'E101 <br /> BUSINESS NAME(Same ss FACILITY NAME«DEA-Doing Buauou Aa) 3. BUSINESS PHONE 102. <br /> Stockton Armory and organization Maintenance Shop 24(CAARNG) 209-983-5416 or 983-5485 <br /> BUSINESS STT.ADDRESS 103, <br /> 8020 S. Airport Way <br /> CITY 104. ZIP CODE 105. <br /> Stockton CA 95206-3999 <br /> DUN&BRADSTREET 106. SIC CODE(4 digit#) 101. <br /> 9711 <br /> COUNTY <br /> IN. <br /> San Juanuin <br /> BUSINESS OPERATOR NAME los. BUSINESS OPERATOR PHONE Ila. <br /> California Army National Guard 209-983-5416 <br /> II BUSINESS OWNER <br /> OWNERNAME w OWNERPHONE 112. <br /> Cailfornia Military Departmen(D.O.D.) 916-854-3691 <br /> OWNER MAILING ADDRESS 113. <br /> 9800 Goethe Road(ATTN:Dan Aguirre) <br /> CITY 114. STATE u% ZIPCODE Ga. <br /> Sacramento CA 95826-9101 <br /> III. MIItON ENTAL CONTACT <br /> fl ACI'NAME Iv. CONTACTPHONE 118_ <br /> _ Dan Aguirre 916-854-3691 <br /> CONTACT MAILING ADDRESS 119. <br /> 9800 Goethe Road <br /> CITY 120. STATE 121. ZIP CODE 122. <br /> Sacramento CA 95826-9101 <br /> -PRIMARY- W. EMERGENCY CONTACTS SECONDARY- <br /> NAME 123 NAME 128. <br /> SFC Mark Young Joel Forsythe <br /> TITLE 124. TITLE 129. <br /> Automotive Supervisor Automotive Worker <br /> BUSINESS PHONE 125, BUSINESS PHONE 130. <br /> 209-983-5416 209-983-5485 <br /> 24-HOUR PHONE* 126, 24-HOUR PHONE* 131. <br /> 209-786-9458 209-312-0532 <br /> PAGER# In PAGER# 132. <br /> ADDITIONAL LOCALLY COLLECTED INFORMATION: 133. <br /> Property Owner:Cailfomia Military Departmen(D.O.D.) Phone No.: 916-854-3500 <br /> Billing Address: 9800 Goethe Road Sacramento Ca. 95826-9101 <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 and <br /> -1 familiar with the information submitted and believe the information is true,accurate,and complete. <br /> IATURE OF OWNER/OPERATOR OR DESIGNATED REPRESENTATIVE DATE IN. NAME OF DOCUMENT PREPARES 135. <br /> Mazk Youn <br /> NAME OF SIGNER(print) 136. TITLE OF SIGNER UZ <br /> JGel Forsythe Automotive Worker <br /> See instructions on next page. <br /> UPCF hwR730(1/99)-1/2 http://www.mido".org Rev.04/17/00 <br />