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n <br />BUSINESS OWNER/OPERATOR IDENTIFICATION FORM <br />SIDE 1 <br />,GINNING DATE (1) I. IDENTIFICATION (3) PAGE i OF� <br />BUSINESS NAME (4) BUSINESS PHONE (5) - <br />Forward Landfill Inc. 1(209) 982-4298 <br />SITE ADDRESS (6) <br />9999 Austin Rd. <br />:Street No. Direction Wreet Name Street 1 ype A tlblct /Suite <br />CITY (7) rt�.nteca STATE (8)ZIP (9) CA 95336 <br />DUN & (10) SIC CODE (4 DIGIT #) (11) <br />B RADSTREET 1 05-618-3791 <br />OPERATOR (12) OPERATOR PHONE (13) <br />NAME ' L. T,awrnncA Rut C31 •Srtef33ki . F ( 209) AR7- <br />II. BUSINESS OWNER _ <br />OWNER NAME (14) OWNER PHONE (15) <br />Allied Waste Ind. <br />OWNER ADDRESS (16) <br />(If different from Entries #6 or#41) 15880 N. Greenway—Hyden Loop, Suite 1,00 <br />CITY (17) STATE (18) F ZIP (19) <br />Scttsdale AZ f3526�3 <br />III. ENVIRONMENTAL CONTACT <br />CONTACT NAME (20) CONTACT PHONE (2 1)-- -Lawrence Butch Stefani (209) 982-4298 <br />)NTACT ADDRESS (22) <br />kif different from Entries #6 <br />or #41) Street No. Direction Street Name Street Type Apt/Bldg/Suite <br />CITY (23) 1 STATE (24) 1 ZIP (25) <br />Primary IV. EMERGENCY CONTACTS Secondary <br />NAME (26) <br />Lawrence Butch Stefani <br />TITLE (27) <br />BUSINESS PHONE (28) <br />209)982-4298 <br />24-HOUR PHONE (29) <br />(After Business Hours) <br />PAGER # (30) <br />NAME (31) <br />Ruben Ramirez <br />TITLE (32) <br />BUSINESS PHONE (33) <br />24-HOUR PHONE (34) <br />(After Business Hours) <br />PAGER # (35) <br />209) 982-,4298 <br />209) 969-9952 <br />ON-SITE EHS (36) YESNO If yes, and above Threshold Quantities, attach a sheet of paper with a general <br />description of the process and principle equipment. <br />ADDITIONAL LOCALLY COLLECTED INFORMATION (37) Provide information requested on the back of this form <br />"TAME OF DOCUMENT PREPARER (38) <br />NAME OF OWNER/OPERATOR (39) <br />Lawrence Butch Stefani <br />DATE (40) , <br />SJC 12/00 <br />