Laserfiche WebLink
VINIFIED PROGRAM CONSOLIDATED F <br /> FACILITY INFORMATION <br /> BUSINESS OWNER/OPERATOR IDENTIFICATION <br /> Page of <br /> I. IDENTIFICATION <br /> FACILITY ID If 1. BEGIN ING DATE IW. ENDING DATE 101' <br /> (Agency Use only) ID <br /> BUSINESS NAME(Same as Facility Name or DBA—Doing Business As) 3. BUSINESS PHONE 102, <br /> Valero Corner Store #3698 209 832-8815 <br /> BUSINESS SITE ADDRESS 103. BUSINESS FAX 102a. <br /> 153 E. 11th Street ( ) <br /> 108. <br /> BUSINESS SITE CITY 1p0 ZIP CODE 105. COUNTY <br /> Tracy CA 95376 San Joaquin <br /> DUN&BRADSTREET 106, PRIMARY SIC 107. PRIMARY NAICS Ima. <br /> 08-268-6916 5541 <br /> BUSINESS MAILING ADDRESS lova. <br /> 685 West Thrid Street <br /> BUSINESS MAILING CITY lose. STATE logic. ZIP CODE mad. <br /> Hanford CA 93230 <br /> BUSINESS OPERATOR NAME 109 BUSINESS OPERATOR PHONE 110. <br /> Valero California Retail Company (559) 582-0241 <br /> II. BUSINESS OWNER <br /> OWNER NAME111. OWNER PHONE 112. <br /> Valero California Retail Company (559) 582-0241 <br /> 113. <br /> OWNER MAILING ADDRESS <br /> 685 W. Third Street <br /> OWNER MAILING CITY 114. STATE 115. ZIP CODE 116 <br /> Hanford CA 93230 <br /> III. ENVIRONMENTAL CONTACT <br /> CONTACT NAME I1]. CONTACTPHONE 118. <br /> Sandy Huff . (5519 c583-3298 <br /> Ilea <br /> CONTACT MAILING ADDRESS EMAIL <br /> 685 W. third Street sandy.huff@valero.com <br /> CONTACT MAILING CITY lzn STATE 121. ZIP CODE 122. <br /> Hanford CA 93230 <br /> -PRIMARY- IV. EMERGENCY CONTACTS -SECONDARY- <br /> NAME 123. NAME 128. <br /> Ja tar Gill Don Marcetti <br /> 124. TITLE 129. <br /> TITLE <br /> Manager Area Manager <br /> BUSINESS PHONE 125. BUSINESS PHONE 130. <br /> 209 477-3111 209 601-2373 cell <br /> 24-HOUR PHONE <br /> 126. 24-HOUR PHONE 131' <br /> 510 713-1713 209 601-2373 <br /> PAGER# <br /> 127. PAGER tt 32. <br /> ( ) ( ) <br /> ADDITIONAL LOCALLY COLLECTED INFORMATION: 133. <br /> Billing Address: 685 W. Third Street, Hanford, CA 93230 <br /> Property Owner: Phone No.: ( ) <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 OWN OPERATOR OR EJESIONATED REPRESENTATIVE DATE 134. NAME OF DOCUMENT PREPARER 135. <br /> al' S/00 Ild Sandy Huff <br /> NAME OF SIGNER(print) 136. 1 ITLV OF SIGNER 117 <br /> Sandy Huff Compliance Coordinator <br /> UPCF Rev. (12/2007)-1/2 www.unidocs.org <br />