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BUSINESS IDENTIFICATIOY FORM Page 1 of <br /> i <br /> EMAIL BUSINESS ID RECORD <br /> Instructions <br /> BUSINESS OWNER/OPERATOR IDENTIFICATION <br /> FORM . ACCOUNT#: 13151 <br /> I. I D ENTI FICATIO N <br /> BUSINESS LANGE TWINS WINE ESTATES <br /> NAME <br /> BUSINESS PHONE. 209-479-1675 <br /> NUMBER (5) <br /> SITE ADDRE55 JQ 1525 E JAHANT RD <br /> STREET NO DIRECTION STREET NAME STREET TYPE APPT/BLDG/SUITE <br /> CITY j7) ACAMPO STATEA81 CA ZIP (9) 95220 <br /> DUN & <br /> BRADSTREET (10) NIA SIC CODE (4 DIGIT #}- (1]} ':NIA <br /> OPERATOR ............ ............. . <br /> NAME (12) RANDALL#J1NGE OPERATOR PHONE 13 ;20979-1675 <br /> II. BUSINESS OWNER <br /> ------------ ----------_-- <br /> OWNER NAME (.14) RANDY LANGE OWNER PHONE (15) :209_4.79-1675 <br /> OWNER ADDRESS :1298 W. JAHANT RD <br /> (16) <br /> CITY 17 ACAMPO STATE (18) CA ZIP 19 95220 <br /> III. ENVIRONMENTAL CONTACT <br /> CONTACT NAME 20 RANDALL LANGE C�NTACT_PHONE 21 :209.479-1675 <br /> . <br /> CONTACT ADDRESS (22) 1298 W JAHANT <br /> :RD <br /> ....................... ....------------..-...... . .. <br /> If different from #6 or <br /> STREET DIRECTION STREET NAME STREET TYPEAPPT/BLDG/SUITE <br /> #41 NUMBER <br /> _.. ........ .... ...... ........... . CA ZIP 25 95220 <br /> CITY (23) S ACAMPO TATE 24 <br /> - ---- - <br /> http://www.sioesdata.orWaction-lasso?-Database=oes_login&-layout=html&-response=-chmirf_upd... 10/4/200 <br />