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a t I F I I- a• �* <br />Ll <br />I. IDENTIFICATION <br />BUSINESS NAME (4)CALIFORNIA(N: BUSINESS PHONE (5) <br />LIPATROL-STKN <br />SITE ADDRESS (6) 3330 - N❑ AD ART ) <br />5trcast No. Dlttm:tWa, Street Nam <br />CITY (7) [STOCKTON STATE (8) El <br />ZIP (9) <br />DUN & (10)013062497 SIC CODE (4 DIGIT#) (11) [92 <br />BRADV1 BEET <br />OPERATOR (12)STATE OF CALIF OPERATOR PHONE (13) 209.94 <br />NAME <br />OWNER NAME (14) ISTATE OF CALIFORNIA <br />OWNER MAILING ADDRESS (16) <br />(If different from site s) <br />CITY (I7) <br />OWNER PHONE (15) <br />STATE (18) 1 j ZIP (19) <br />Aecvw #: <br />15 <br />CONTACT NAM13 (20) ILT E WHITBY I CONTACT PHONE (21) Imo -943.8666 <br />MAII.TNG ADDRESS (22) (� <br />Of dittextmur from site atidsrss)L,_Jj <br />Street No. Duucnon Serax Name tr®et D e 6aIdEZ&AW <br />CITY (23) STATE (24) D <br />ZIP (25) <br />Pramary IV. EMERGENCY CONTACTS Sccomim <br />NAME (26) NAME(3j) <br />EDW TBY CRAIG OLIVER �7 <br />1111E (27) <br />BUSINESS PRONE (28) 209�943�8666 <br />24-HOUR PHONE (29) �-943-8600 <br />PAGER # (30) NIA <br />TIME (32) LIEUTENANT <br />BUSINESS 1'HONL (33) <br />[209- <br />924 xO11R Pxo(14)� <br />- <br />PAGER # (3S) A <br />ON-SITE EIiS (36) NO If Y", and above 'li mhold Planting Quantities, attach a sheet of paper with a gcneral <br />description of the process and principle equipmem involved with the EHS. <br />w mm man n i .w�awm <br />ADDITIONAL LOCALLY COLLECTED INFORMATION (37) Provide information requested on the 2nd page of this forru <br />NAME OF DOCUMENT PREPARER (38) EDWARD WHITBY <br />NAME OF OWNEWOPERATOR (39) JjTATE OF CALIFORNIA DATE (40) -� <br />60120 39Vd <br />NOiAjOiS dHO <br />T99BEP660ZT LZ:60 L00Z/90190 <br />