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FIED PROGRAM CONSOLIDATED FO <br />FACILITY INFORMATION <br />BUSINESS OWNER/OPERATOR IDENTIFICATION <br />FACILITY ID# <br />F A O O O <br />BUSINESS NAME (same as FACILITY NAME or DBA —Doing Business As) <br />7 -Eleven #19976 <br />BUSINESS SITE ADDRESS <br />1399 N. Main <br />CITY <br />Manteca <br />DUN & BRADSTREET <br />00-734-7602 <br />COUNTY <br />San Joaquin <br />BUSINESS OPERATOR NAME <br />Page of <br />,N <br />BEGINNING DATE 100 ENDING DATE <br />8/1/06 12/31/07 <br />3 BUSINESS PHONE <br />209-239-3252 <br />ZIP CODE <br />CA 95336 <br />106 SIC CODE (4 digit #) <br />5541 <br />Manjit & Gurpal Grewal 209-239-3252 <br />II. BUSINESS OWNER <br />OWNER NAME 111 OWNER PHONE <br />7 -Eleven, Inc. 253-796-7170 <br />OWNER MAILING ADDRESS <br />P.O. Box 711 Attn: Gasoline Acctg <br />CITY <br />Dallas <br />III. E <br />CONTACT NAME <br />Randy Martin <br />CONTACT MAILING ADDRESS <br />P.O. Box 711 Attn: Gasoline Acctg <br />TX <br />NVIRONMENTAL CONTACT <br />117 <br />5 ZIP CODE <br />75221-0711 <br />CONTACT PHONE <br />253-796-7170 <br />CITY 120 STATE 121 ZIP <br />Dallas TX 752 <br />-PRIMARY- <br />NAME <br />7 -Eleven Emergency Dispatch I <br />TITLE <br />Emergency Service <br />BUSINESS PHONE <br />1800-828-0711 <br />24-HOUR PHONE <br />PAGER # <br />ADDITIONAL LOCALLY COLLECTED INFORMATION <br />IV. EMERGENCY CONTACTS <br />123 NAME <br />7 -Eleven Emergency Dispatch 1 <br />124 TITLE <br />Emergency Service <br />125 BUSINESS PHONE <br />800-828-0711 <br />126 24-HOUR PHONE <br />108 <br />,1100 <br />112 <br />113 <br />116 <br />118 <br />119 <br />CODE 122 <br />21-0711 <br />-SECONDARY- <br />128 <br />129 <br />130 <br />131 <br />132 <br />Certification: Based 6n rry'inqui f thos individuals responsible for obtaining the information, I certify under penalty of law that I have personally <br />examined and ,71r ' far with a inf ation submitted and believe the information is true, accurate, and complete. <br />SIGNATURE ER/O OR D IGNATED REPRESENTATIVE DATE 13a NAME OF DOCUMENT PREPARER 135 <br />8/14/06 Rachel Rodriguez <br />NAME OF S) NER (pri q <br />136 TITLE OF SIGNER 137 <br />Randy Martin Gasoline & Environmental Compliance Manager <br />UPCF ( 1/99 revised) HMP 2 (Back) Instructions CES FORM 2730 <br />(1/99) <br />