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1E14BUSESS OWNER/OPERATOR IDENTIFICATION FORM II Account #: 363 I <br />L IDENTIFICATION <br />BUSINESS NAME (4) CALIFORNIA TANK LINES INC BUSINESS PHONE (5) 1209-466-3554 <br />SITE ADDRESS (6) 13105 IFIEL <br />DORADO ST <br />Street No. Direction Street Name Street Type A t/Bld Suite <br />CITY (7) ISTOCKTON STATE (8) CA ZIP (9) 195206 <br />DUN & (10) 00-477-1606 SIC CODE (4 DIGIT #) (11) 4213 <br />BRADSTREET <br />OPERATOR (12) MICHAEL ELLIS OPERATOR PHONE (13) 209-466-3554 <br />NAME <br />H. BUSINESS OWNER <br />OWNER NAME (14) CALIFORNIA TANK LINES OWNER PHONE (15) 1209-466-3554 <br />OWNER MAILING ADDRESS (16) P.O. BOX 6245 <br />(If different from site address) <br />CITY (17) STOCKTON I STATE (18) [CA -1 ZIP (19) 95206 <br />III. ENVIRONMENTAL CONTACT <br />CONTACT NAME (20) JACK BISHOP CONTACT PHONE (21) 1209-4663554 <br />MAILING ADDRESS (22) <br />(If different from site address) ❑rp- 0. BOX 6245 <br />Street No. Direction Street Name Street Type Apt/Bldg/Suite <br />CITY (23) I_ I STATE (24) 1_ . I ZIP (25) <br />Primary IV. EMERGENCY CONTACTS Secondary <br />NAME (26) MICHAEL ELLIS I I <br />NAME (31) JACK BISHOP <br />TITLE (27) ���_..�_._.... TITLE (32) <br />BUSINESS PHONE (28) IMO AACK 2ccA I I BUSINESS PHONE (33) <br />24-HOUR PHONE (29) 111nn Acc 1ecA 11 24-HOUR PHONE (34) <br />PAGER # (30) 1unrzV I I PAGER # (35) <br />SUPERVISOR <br />EXTREMELY HAZARDOUS SUBSTANCES (EHS) <br />ON-SITE EHS (36) YES IIf yes, and above Threshold Planning Quantities, attach a sheet of paper with a general <br />description of the process and principle equipment involved with the EHS. <br />ADDITIONAL LOCALLY COLLECTED INFORMATION (37) Provide information requested on the 2nd page of this form <br />NAME OF DOCUMENT PREPARER (38) <br />JACK BISHOP / CINDY KOCHEVAR <br />NAME OF OWNER/OPERATOR (39) MICHAEL ELLIS DATE (40) <br />