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BUSINESS IDENTIFICATION' FORM Page 2 of 3 <br /> NUMBER (30) NUMBER (35) <br /> EXTREMELY HAZARDOUS SUBSTANCES (EHS) <br /> ON-SITE EH&S (36) NOIf yes, and above Threshold Quantities, attach a sheet of paper with a general <br /> description of the process and principle equipment. <br /> ADDITIONAL LOCALLY COLLECTED INFORMATION (37) <br /> NAME OF DOCUMENT PREPARER PAUL BRINK <br /> (38) <br /> NAME OF OWNER/OPERATOR 39 ANTHONY MATTIOLI DATE 40 <br /> BUSINESS MAILING AND BILLING INFORMATION <br /> MAILING ADDRESS (41) <br /> (If different from Site Address(6), otherwise leave blank.) <br /> NOTE: ALL TIME SENSITIVE AND OFFICIAL CORRESPONDENCE WILL BE SENT TO THIS ADDRESS <br /> 148 N WILSON WAY <br /> STREET NUMBER DIRECTION STREET NAME STREET TYPE <br /> STOCKTON CA 95205 <br /> CITY STATE ZIP <br /> BILLING ADDRESS (42) <br /> (If different from Mailing Address(41),otherwise leave blank.) <br /> NOTE:INCLUDE"CARE OF' INFORMATION <br /> STREET NUMBER DIRECTION STREET NAME STREET TYPE <br /> CITY STATE ZIP <br /> ADDITIONAL BUSINESS INFORMATION <br /> PE OF r Single Owner r Corporation r Partnership Public Agency <br /> ORGANIZATION (43) <br /> UNSTAFFED SITE NO <br /> NETWORK (44) <br /> ASSESSOR PARCEL NO. (45) 117-360-29 <br /> PROPERTY OWNER SHELDON HACKMAN PHONE NO. (47) 209-466-2411 <br /> NAME (45) <br /> PROPERTY OWNER 2211 N WILSON WAY <br /> http://sjoesdata.org/oes hmmp/section_tables/CHMIRF_ps_review.lasso?-Database=transa... 3/2/2010 <br />