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OFIED PROGRAM CONSOLIDATED F00 FACILITY INFORMATION BUSINESS OWNER/OPERATOR IDENTIFICATION Page I of 4 I.IDENTIFICATION FACILITY ID BEGINNING DATE ENDING DATE # 1/l/2009 12/3l/2009 BUSINESS NAME(Same as FACILITY NAME or DBA-Doing Business As) BUSINESS PHONE: Chevron Station#208118 209-477-3699 BUSINESS ADDRESS 3355 E Hammer Ln BUSINESS FAX: CITY ZIP CODE COUNTY Stockton CA 95212 AGENCY DUN&BRADSTREET PRIMARY SIC PRIMARY NAICS 00-914-0559 5541 447110 BUSINESS MAILING ADDRESS P.O.Box 6004,Attn Permit Desk BUSINES MAILING CITY STATE ZIP CODE San Ramon �CA 94583 BUSINESS OPERA'T'OR NAME BUSINESS OPERATOR PHONE Chevron Stations Inc. 209-477-3699 II.BUSINESS OWNER OWNER NAME OWNER PHONE Chevron Products Company,Attn:Permit Desk (925)842-9002 OWNER MAILING ADDRESS P.O.Box 6004 CITY STATE ZIP CODE San Ramon �CA 94583 III.ENVIRONMENTAL CONTACT CONTACT NAME CONTACT PHONE Chevron Products Company,Attn:Permit Desk (925)842-9002 CONTACT MAILING ADDRESS CONTACT EMAIL P.O.BOX 6004 cbittle chevron.com CITY STATE ZIP CODE San Ramon CA 94583-0904 -PRIMARY IV.EMERGENCY CONTACTS SECONDARY NAME: NAME: Manager Chevron Emergency Information Center TITLE: TITLE: Station Operator Staff BUSINESS PHONE: BUSINESS PHONE: 209-477-3699 800-231-0623 24-HOUR PHONE: 24-HOUR PHONE: 800-231-0623 800-231-0623 PAGER#: PAGER#: ADDITIONAL LOCALLY COLLECTED INFORMATION BILLING ADDRESS:Chevron Products Company Attn: Permit Desk,P.O.BOX 6004, San Ramon, CA 94583 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 am familiar with the information submitted elieve the information is true accurate and complete. Signature of Owner/Operator DATE NAME OF DOCUMENT PREPARER �� t z 06/12/2009 JIM HARTMAN NAME OF SIGNER (print) TITLE OF SIGNER Chevron Products Co./JI TMAN Retail HES Permit Desk UPCF Rev.(12/2007)