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UNIFIED PROGRAM CONSOLIDATED FORM <br /> FACILITY INFORMATION <br /> B SINESS OWNER/OPERATOR IDENTIFICATION <br /> (1/27/2011 -07:22:13 PM) <br /> Page of <br /> I. IDENTIFICATION <br /> FACILITY IDH 7527 1 1 BEGINNING DATE N/A 100 1 ENDING DATE N/A 101 <br /> BUSINESS NAME(Same as FACIL TY NAME or DBA-Doing Business As) 3 BUSINESS PHONE 102 <br /> QUALITY TUNE UP SHOPS 209-547-9084 <br /> BUSINESS SITE ADDRESS 103 BUSINESS FAX 102a <br /> 1014 N ELDORADO ST Not Collected <br /> BUSINESS SITE CITY 104 ZIP CODE 105 COUNTY 108 <br /> STOCKTON CA 95202 SAN JOAQUIN <br /> DUN&BRADSTREET 106 PRIMARY SIC 107 PRIMARY NAICS 107a <br /> N/A 7549 Not Collected <br /> BUSINESS MAILING ADDRESS J� 108a <br /> k, <br /> BUSINESS MAILING CITY 1086 STATE 108c ZIP CODE 108d <br /> BUSINESS OPERATOR NAME 109 BUSINESS OPERATOR PHONE 110 <br /> GERALD GARDUNO 209-547-9084 <br /> II. BUSINESS OWNER <br /> OWNER NAME(14) 111 1 OWNER PHONE(15) 112 <br /> GERALD GARDUNO 209-547-9084 <br /> OWNER MAILING ADDRESS 113 <br /> OWNER MAILING CITY 114 STATE 115 ZIP CODE 116 <br /> I1I. ENVIRONMENTAL CONTACT <br /> CONTACT NAME I l7 CONTACT PHONE 118 <br /> GERALD GARDUNO 209-547-9084 <br /> CONTACT MAILING ADDRESS 119 CONTACT EMAIL 119a <br /> gardunol@aol.com <br /> CONTACT MAILING CITY 120 STATE 121 ZIP CODE 122 <br /> IV. EMERGENCY CONTACTS <br /> NAME 123 NAME 128 <br /> GERALD G UNO JOHN HEWITT /JOSE OSARIO <br /> TITLE 124 TITLE 129 <br /> FRANCHISE TECH <br /> BUSINESS PHONE 125 BUSINESS PHONE 130 <br /> 209-547-9084 209-547-9084 <br /> 24-HOUR PHONE 209-601-8335 126 24-HOUR PHONE 209 649-6690 131 <br /> PAGER/CELL H N/A 127 PAGER/CELL H 209 688-2287 132 <br /> ADDITIONAL LOCALLY COLLET ED INFORMATION: 133 <br /> COMPLET PAGE 2 OF BUSINESS OWNER/OPERATOR IDENTIFICATION <br /> Certification: Based on my inquiry of rhos individuals responsible for obtaining the information,1 certify under penalty of law by signing below or certifying by the <br /> established processes on the Administerrin Agency's HMMP Compliance Website that I have personally examined and am familiar with the informaiton submitted and <br /> believe the information is true,accurate,an complete <br /> SIGNATURE OF OWNER/OPERAT R OR DESIGNATED REPRESENTATIVE DATE 134 NAME OF DOCUMENT PREPARER 135 <br /> NAME OF SIGNER(print) 136 TITLEOFSIGNER 137 <br /> UPCF(Rev. 12/2007) <br />