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BUSINESS IDENTIFICATIOI l FORM Page 1 of 3 <br /> Main Menu <br /> BUSINESS OWNER/OPERATOR IDENTIFICATION ACCOUNT#: 10641 <br /> DATA ENTRY <br /> I. IDENTIFICATION <br /> BUSINESS NAME (4)CONNELL TIRE SERVICE BUSINESS PHONE NUMBER (5) (209) 465-1365 <br /> SITE ADDRESS (6) 2211 N WILSON WAY <br /> STREET NO DIRECTION STREET NAME STREET TYPE APPT/BLDG/SUITE <br /> CITY (7) STOCKTON STATE (8) CA ZIP (9) 95205 <br /> DUN & <br /> BRADSTREET (10) 02-950-6565 SIC CODE (4 DIGIT #) (11) 5014 <br /> OPERATOR <br /> NAME (12) ANTHONY MATTIOLI OPERATOR PHONE (13) 209-465-0281 <br /> II. BUSINESS OWNER <br /> OWNER NAME (14) ANTHONY MATTIOLI OWNER PHONE (15) 209-465-0281 <br /> OWNER ADDRESS (16) <br /> CITY (17) STATE (18) ZIP (19) <br /> III. ENVIRONMENTAL CONTACT <br /> CONTACT NAME (20) MIKE MURRAY CONTACT PHONE (21) 209-465-1365 <br /> CONTACT ADDRESS (22) STREET DIRECTIONSTREET NAMESTREET TYPEAPPT/BLDG/SUITE <br /> If different from NUMBER <br /> #6 or #41 <br /> CITY (23) STATE (24) ZIP (25) <br /> IV. EMERGENCY CONTACTS <br /> PRIMARY SECONDARY <br /> NAME (26) MIKE MURRAY NAME (31) PAUL BRINK <br /> TITLE (27) MANAGER TITLE (32) OPERATIONS <br /> BUSINESS 209-465-1365 BUSINESS 209-465-0281 <br /> PHONE (28) PHONE (33) <br /> 24 HOUR 209-461-5521 24 HOUR 209-461-5521 <br /> PHONE (29) PHONE (34) <br /> (AFTER BUSINESS (AFTER BUSINESS HOURS) <br /> HOURS) <br /> PAGER/CELL PAGER/CELL <br /> http://sjoesdata.org/oes_hmmp/section_tables/CHMIRF_ps_review.lasso?-Database=transa... 3/2/2010 <br />