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BUSINESS IDENTIFICATION FORM http://sjoesdata.org/o htnmp/secrion_tables/CHAIW_ps_review.l... <br /> Main Menu <br /> BUSINESS OWNER/OPERATOR IDENTIFICATION ACCOUNT#: 554 <br /> DATA ENTRY <br /> I. IDENTIFICATION <br /> BUSINESS NAME CUSTOM METAL FINISHING BUSINESS PHONE NUMBER 209-463-5811 <br /> SITE ADDRESS 1550 SHAW RD #C <br /> STREET NO DIRECTION STREET NAME STREET TYPE APPT/BLDG/SUITE <br /> CITY STOCKTON STATE CA ZIP 95215 <br /> DUN& <br /> BRADSTREET 02-394-173 SIC CODE(4 DIGIT#) 3471 <br /> OPERATOR NAME NEIL DAVIS &TERRI TAYLOR OPERATOR PHONE 209-463-5811/209-505-0037 <br /> II. BUSINESS OWNER <br /> OWNER NAME(14) NEIL DAVIS &TERRI TAYLOR OWNER PHONE (15) 209-918-0815 <br /> OWNER ADDRESS 4212 ELDENBERRY CT <br /> (16) <br /> CITY MODESTO STATE CA ZIP 95356 <br /> III. ENVIRONMENTAL CONTACT <br /> CONTACT NAME TERRITAYLOR CONTACTPHONE 209-505-0037 <br /> CONTACT ADDRESS 0 <br /> If different from STREET DIRECTIONSTREET NAMESTREET TYPE APPT/BLDG <br /> site or mailing address NUMBER /SUITE <br /> CITY STATE ZIP <br /> IV. EMERGENCY CONTACTS <br /> PRIMARY SECONDARY <br /> NAME NEIL DAVIS NAME TERRITAYLOR <br /> TITLE OWNER/PARTNER TITLE OWNER/ PARTNER <br /> BUSINESS PHONE 209-463-5811 BUSINESS PHONE 209-463-5811 <br /> 24 HOUR PHONE 209-918-0815 24 HOUR PHONE 209-505-0037 <br /> (AFTER BUSINESS HOURS) (AFTER BUSINESS HOURS) <br /> PAGER NUMBER N/A PAGER NUMBER N/A <br /> EXTREMELY HAZARDOUS SUBSTANCES (EHS) <br /> ON-SITE EH&S NOIf yes, and above Threshold Quantities,attach a sheet of paper with a general <br /> description of the process and principle equipment. <br /> ADDITIONAL LOCALLY COLLECTED INFORMATION <br /> NAME OF DOCUMENT PREPARER TERRITAYLOR <br /> NAME OF OWNER/OPERATOR NEIL DAVIS/TERRI DATE <br /> TAYLOR <br /> BUSINESS MAILING AND BILLING INFORMATION <br /> MAILING ADDRESS <br /> (I different from SRe Address,athemise leave blank.) <br /> NOTE:ALL TIME SENSITIVE AND OFFICIAL CORRESPONDENCE WILL BE SENT TO THIS ADDRESS <br /> I of 2 7/29/2009 8:40 AM <br />