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r-1 <br />0_5 LIP <br />I IED PROGRAM CONSOLIDATED FOR . <br />FACILITY INFORMATION <br />BUSINESS OWNER/OPERATOR IDENTIFICATION <br />Page of <br />I. IDENTIFICATION <br />FACILITY ID # <br />1 <br />BEGINNING DATE 100 <br />ENDING DATE <br />(Agency Use Only) <br />- <br />- <br />1/1/2009 <br />12/31 /2009 <br />BUSINESS NAME (Same as Facility Name or DBA - Doing Business As) 3. <br />BUSINESS PHONE 102. <br />7 -Eleven # 19976 <br />(209) 239-3252 <br />BUSINESS SITE ADDRESS 103. <br />BUSINESS FAX Ima. <br />1399 N. Main <br />( ) <br />BUSINESS SITE CITY "'' <br />ZIP CODE 105. <br />COUNTY 108. <br />Manteca <br />CA <br />95336 <br />San Joaquin <br />DUN & BRADSTREET 106, <br />PRIMARY SIC 107. <br />PRIMARY NAICS 107a. <br />00-734-7602 <br />5541 <br />BUSINESS MAILING ADDRESS 108a. <br />P.O. Box 711 Attn: Environmental Department <br />BUSINESS MAILING CITY 1086. <br />STATE 10k. <br />ZIP CODE 1084. <br />Dallas <br />TX I <br />75221 <br />BUSINESS OPERATOR NAME 109. <br />BUSINESS OPERATOR PHONE 110. <br />Man'it & Gur al Grewal <br />(209) 239-3252 <br />II. BUSINESS OWNER <br />OWNER NAME 111• <br />OWNER PHONE 112. <br />7 -Eleven, Inc. <br />(800) 828-0711 <br />OWNER MAILING ADDRESS 113. <br />P.O. Box 711 Attn: Environmental Department <br />OWNER MAILING CITY <br />STATE 115. <br />ZIP CODE 116. <br />Dallas 7TX <br />1 <br />75221 <br />III. ENVIRONMENTAL CONTACT <br />CONTACT NAME 117. <br />CONTACT PHONE 118. <br />Ian Moorhead <br />(916) 463-6776 <br />CONTACT MAILING ADDRESS 119. <br />CONTACT EMAIL 119a. <br />P.O. Box 711 Attn: Environmental Department <br />ian.moorhead@7-11.com <br />CONTACT MAILING CITY 120• <br />STATE 121. <br />ZIP CODE 122. <br />Dallas <br />1 TX <br />75221 <br />-PRIMARY- IV. EMERGENCY <br />CONTACTS -SECONDARY- <br />NAME 123. <br />NAME 128. <br />Man'it & Gur al Grewal <br />Dispatch I <br />TITLE 124. <br />TITLE 129. <br />Franchisee <br />Emergency Service <br />BUSINESS PHONE 125. <br />BUSINESS PHONE 130. <br />(209) 239-3252 <br />(800) 828-0711 <br />24-HOUR PHONE 126• <br />24-HOUR PHONE 131. <br />(800) 828-0711 <br />(800) 828-0711 <br />PAGERI# 127. <br />1 <br />PAGER # 132• <br />( ) <br />ADDITIONAL LOCALLY COLLECTED INFORMATION: 133. <br />Billing Address: P.O. Box 711 Attn: Environmental Department, Dallas, TX 75221-0711 <br />Property Owner: 7 -Eleven Inc. Phone No-: (800) 828-0711 <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 />SIGNAT F OWNER/OPERATOR OR DESIGNATED REPRESENTATIVE <br />DATT�134. <br />NAME OF DOCUMENT PREPARER 135. <br />r <br />�/71/o A <br />Pat Banks <br />NAME OF SIGNER (print) 130• <br />TITLE OF SIGNER 137. <br />Ian Moorhead <br />Environmental Compliance Manager <br />UPCF Rev. (1212007) - 1/2 www.unidocs.org <br />