COMPLIANCE INFO_FILE 1 1986-2012

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Business Owner _ erator Identification Page (OES For 2730) Instructions Except when using the Hazardous Materials Business Plan Certification Form, you must submit the Business Activities page, the Business Owner/Operator Identification page, and Hazardous Materials - Chemical Description pages with all hazardous materials inventory submittals. (Note: Numbering of these instructions follows the UPCF data element numbers on the Owner/Operator page.) 1. FACILITY ID NUMBER - This number is for agency use only. Leave this space blank. 3. BUSINESS NAME - Enter the complete Facility Name. 100. BEGINNING DATE-Enter the beginning year and date of the report. 101. ENDING DATE-Enter the ending year and date of the report. 102. BUSINESS PHONE-Enter the phone number,including area code and any extension. 103. BUSINESS SITE ADDRESS - Enter the street address where the facility is located, including building number, if applicable. Post office box numbers are not acceptable. This information must provide a means to locate the facility geographically. 104. CITY-Enter the city or unincorporated area in which the facility is located. 105. ZIP CODE-Enter the 5 or 9 digit zip code for the facility. 106. DUN&BRADSTREET-If the business has a D&B number,enter it here. 107. SIC CODE-Enter the 4 digit Standard Industrial Classification Code number for the facility's primary business activity. 108. COUNTY-Enter the name of the county in which the facility is located. 109. BUSINESS OPERATOR NAME-Enter the name of the facility operator. 110. BUSINESS OPERATOR PHONE-Enter the operator's phone number,including area code and any extension. 111. OWNER NAME-Enter the name of the facility owner,if different from the operator. 112. OWNER PHONE-Enter the owner's phone number,including area code and any extension. 113. OWNER MAILING ADDRESS-Enter the owner's street or P.O.box mailing address,if different from the site address. 114. OWNER CITY-Enter the name of the city for the owner's mailing address. 115. OWNER STATE-Enter the 2 character state abbreviation for the owner's mailing address. 116. OWNER ZIP CODE-Enter the 5 or 9 digit zip code for the owner's mailing address. 117. ENVIRONMENTAL CONTACT NAME-Enter the name of the person,if different from the Business Owner or Operator,who will receive all environmental correspondence and will respond to enforcement activity. 118. CONTACT PHONE-Enter the environmental contact's phone number,including area code and any extension. 119. CONTACT MAILING ADDRESS - Enter the street or P.O. box mailing address where all environmental contact correspondence should be sent,if different from the site address. 120. CITY-Enter the name of the city for the environmental contact's mailing address. 121. STATE-Enter the 2 character state abbreviation for the environmental contact's mailing address. 122. ZIP CODE-Enter the 5 or 9 digit zip code for the environmental contact's mailing address. 123. PRIMARY EMERGENCY CONTACT NAME - Enter the name of a representative (i.e. Emergency Coordinator) who can be contacted in case of an emergency involving hazardous materials at the facility. This person shall have full facility access, site familiarity,and authority to make decisions for the business regarding incident mitigation. 124. TITLE-Enter the title of the primary Emergency Coordinator. 125. BUSINESS PHONE-Enter primary Emergency Coordinator's business phone number, including area code and any extension. 126. 24-HOUR PHONE-Enter a phone number that will be answered 24 hours a day. If not the primary Emergency Coordinator's home phone number,then the number of an answering service able to immediately contact the primary Emergency Coordinator must be provided. Please note that this is a public document, so any telephone number provided is available to the general public any time a review of your facility's records is conducted. 127. PAGER NUMBER-Enter the pager number for the primary Emergency Coordinator,if available. 128. SECONDARY EMERGENCY CONTACT NAME - Enter the name of a secondary Emergency Coordinator who can be contacted in the event that the primary Emergency Coordinator is not available. The contact shall have full facility access, site familiarity, and authority to make decisions for the business regarding incident mitigation. 129. TITLE-Enter the title of the secondary Emergency Coordinator. 130. BUSINESS PHONE - Enter secondary Emergency Coordinator's business phone number, including area code and any extension. 131. 24-HOUR PHONE-Enter a phone number for the secondary Emergency Coordinator. See instructions for item 123,above. 132. PAGER NUMBER-Enter the pager number for the secondary Emergency Coordinator,if available. 133. ADDITIONAL LOCALLY COLLECTED INFORMATION-Enter the name and phone number for the property owner. Enter the complete mailing address to which bills for permit fees should be sent,if different from items 119-122,above. SIGNATURE OF OWNER/OPERATOR OR DESIGNATED REPRESENTATIVE - The Business Owner/Operator, or officially designated representative of the Owner/Operator, shall sign in the space provided. This signature certifies that the signer is familiar with the information submitted, and that based on the signer's inquiry of those individuals responsible for obtaining the information,it is the signer's belief that the submitted information is true,accurate,and complete. 134. DATE-Enter the date that the document was signed. 0 135. NAME OF DOCUMENT PREPARER-Type or print the full name of the person who prepared the Business Plan information. 136. NAME OF SIGNER-Type or print the full name of the person signing this document. 137. TITLE OF SIGNER-Enter the title of the person signing this document. UN-020UPCF-6/15 www.unidocs.org Rev.01/16/02