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UNIDOCS <br />FACILITY INFORMATION <br />BUSINESS OWNER/OPERATOR IDENTIFICATION PAGE <br />Page of <br />I. IDENTIFICATION <br />FACILITY ID # <br />1. <br />BEGINNING DATE 100 <br />ENDING DATE 01 <br />(Agency Use Only) <br />- <br />BUSINESS NAME (Same as Facility Name or DBA - Doing Business As) 3. <br />BUSINESS PHONE 102. <br />JC Penne <br />209 951-1110 <br />BUSINESS SITE ADDRESS 103, <br />BUSINESS FAX iota <br />4915 Claremont Ave <br />BUSINESS SITE CITY 104- <br />ZIP CODE 105. <br />COUNTY 1o8. <br />Stockton <br />CA <br />95207 <br />San Joaquin <br />DUN & BRADSTREET 106• <br />PRIMARY SIC 107. <br />PRIMARY NAICS 107x. <br />5311 <br />452111 <br />BUSINESS MAILING ADDRESS 108a. <br />4703 Tidewater Avenue, Suite B <br />BUSINESS MAILING CITY 108b. <br />STATE I OiT <br />ZIP CODE toad. <br />Oakland <br />I CA 194601 <br />BUSINESS OPERATOR NAME 109• <br />BUSINESS OPERATOR PHONE 110. <br />Craig M Waymire Store Manager) <br />209 951-1110 <br />H. BUSINESS OWNER <br />OWNER NAME 111. <br />OWNER PHONE 112. <br />JC Penne <br />972 431-1000 <br />OWNER MAILING ADDRESS 113. <br />6501 Legacy Drive <br />OWNER MAILING CITY 114. <br />STATE 115. <br />ZIP CODE 116. <br />Plano <br />��TX 175024 <br />III. ENVIRONMENTAL CONTACT <br />CONTACT NAME 117. <br />CONTACT PHONE 118. <br />PSI <br />510 434-9200 <br />CONTACT MAILING ADDRESS 119. <br />CONTACT EMAIL 119a. <br />4703 Tidewater Avenue, Suite B <br />ezekiel.robles@psiusa.com <br />CONTACT MAILING CITY 120. <br />STATE 121. <br />ZIP CODE 122. <br />Oakland <br />1 CA 194601 <br />-PRIMARY- IV. EMERGENCY <br />CONTACTS -SECONDARY- <br />NAME 123. <br />NAME 1287 <br />Brad Jennings, JC Penney <br />Ezekiel Robles, PSI <br />TITLE 124. <br />TITLE 1y9- <br />9Cor <br />Corp. <br />. Environmental, Health & Safety Manager <br />Staff Engineer <br />BUSINESS PHONE 125. <br />BUSINESS PHONE 130. <br />972 431-8431 <br />510 434-9200 x22 <br />24-HOUR PHONE 126. <br />24-HOUR PHONE 131. <br />440 364-0464 <br />510 750-2366 <br />PAGER # 127. <br />PAGER # 182. <br />ADDITIONAL LOCALLY COLLECTED INFORMATION: 133. <br />Billing address: 4703 Tidewater Ave. Ste. B Oakland, CA 94.601 <br />Property Owner: JC Penney Phone No.: (972) 431-1000 <br />Certification: Based on my inquiry of those individuals responsible for obtaining the information, I certify under penalty of law that I have personally examined and <br />am familiar with the information submitted and believe the information is true, accurate, and complete. <br />SIGNATURE OF OWNER/OPERATOR OR DESIGNATED REPRESENTATIVE <br />DATE 134. <br />NAME OF DOCUMENT PREPARER 135. <br />t <br />8/1/12 <br />Ezekiel Robles <br />NAME OF SIGNER (print) 136, <br />TITLE OF SIGNER 137. <br />Brad Jennings <br />Corp. Environmental, Health & Safety Manager <br />UN-UZU www.unidoes.org 5/17 - Rev. 12/14/10 <br />