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I <br /> BUSINESS OWNER/OP RA7 IDENTIFICATION FORM tunt#: nznz <br /> BEGINNING DATE (1) 1/ /201 I I. IDENTIFICATION (3) PAGE 1 OF <br /> BUSINESS NAME 4) Va ero Corner Store#3698 BUSINESS PHONE(5) 209-832-8815 <br /> SITE ADDRESS 6) 15 a 11`t' Street <br /> Stree No. Direction Street Name Street Type Apt/Bldg/Suite <br /> CITY 7) Tra cy STATE(8) FC I ZIP(9) 95376 <br /> DUN& 10) SIC CODE(4 DIGIT#) (11) 5541 <br /> BRADSTREET FO8-268-6916 <br /> OPERATOR (12) Val ro California Retail Company OPERATOR PHONE (13) 559-582-0241 <br /> NAME <br /> II.BUSINESS OWNER <br /> OWNER NAME (14 California Retail Company OWNER PHONE (15) 559-582-0241 <br /> Valero <br /> OWNER ADDRESS (16) 685 W.Third Street <br /> (If different from Entries#6 or#41) <br /> CITY (17) Hanford STATE (18) ZIP (19) 93230 <br /> III.ENVIRONMENTAL CONTACT <br /> CONTACT NAME ( 0) San y Huff CONTACT PHONE (2 1) 559-583-3298 <br /> CONTACT ADDRES (22) 85 Third St <br /> Street No. Direction Street Name Street Type Apt/Bldg/Suite <br /> CITY (17) Hanford STATE (24) CA ZIP (25) 93230 <br /> Pi imary IV.EMERGENCY CONTACTS Secondary <br /> NAME(26) Ja�tar ill NAME(3 1) Don Marcetti <br /> TITLE(27) TITLE(32) <br /> Manag r Area Manager <br /> BUSINESS PHONE(2 ) 209 32-8815 BUSINESS PHONE(33) 209-601-2373(cell) <br /> 24-HOUR PHONE(29 510- 13-1713 24-HOUR PHONE(34) <br /> (After Business Hours) (After Business Hours) 209-601-2373 <br /> PAGER#(30) PAGER#(35) <br /> EXTREMELY HAZARDOUS SUBSTANCES(EHS) <br /> ON-SITE EHS (36) If yes,and above threshold Quantities,complete an EHS Description Page for each <br /> no appropriate material when completing its Chemical Description Page. <br /> ADDITIONAL LOCALLY COLLECTED INFORMATION(37) Provide information requested on the back of this form <br /> NAME OF DOCUME T PREP R(38) Sandy Huff <br /> NAME OF OWNER/O ERATO Z(39) DATE(40) <br /> Valero California Retail Company 1/26/2011 <br />