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UNIFIED PROGRAM CONSOLIDATED FORM <br /> FACILITY INFORMATION <br /> BUS NESS OWNER/OPERATOR IDENTIFICATION <br /> Page of <br /> I. IDENTIFICATION <br /> FACILITY ID# EGINNING DATE ��� ENDING DATE 101 <br /> (Agency Use only) — — 1413 �413T7 <br /> /1/2011 12/31/2011 <br /> BUSINESS NAME(Same as Facility Naj ne or DBA—Doing Business As) 3. BUSINESS PHONE 102. <br /> Valero Corner Sto a #3698 R 209 832-8815 <br /> BUSINESS SITE ADDRESS 103. BUSINESS FAX 102a. <br /> 153 E. 11th Street ( ) <br /> BUSINESS SITE CITY 104. ZIP CODE 105• COUNTY 108• <br /> Tracy CA 95376 San Joaquin <br /> DUN&BRADSTREET 106. PRIMARY SIC 107. PRIMARY NAILS 107x. <br /> 08-268-6916 5541 <br /> BUSINESS MAILING ADD ESS 108a. <br /> 685 West Thrid St tet <br /> BUSINESS MAILING CITY 108b, I STATE 108c• ZIP CODE 1084. <br /> Hanford CA 93230 <br /> BUSINESS OPERATOR NAME 109. BUSINESS OPERATOR PHONE 110. <br /> Valero California Retail Company (559) 582-0241 <br /> II. BUSINESS OWNER <br /> OWNER NAME 111. OWNER PHONE 112. <br /> Valero California Retail C m an (559) 582-0241 <br /> OWNER MAILING ADDRESS 11�. <br /> 685 W. Third Street <br /> OWNER MAILING CITY 114. STATE 11.5 ZIP CODE <br /> Hanford CA 93230 <br /> III. ENVIRONMENTAL CONTACT <br /> CONTACT NAME 117• CONTACT PHONE <br /> Sandy Huff (559) 583-3298 <br /> CONTACT MAILING ADDRESS 119. CONTACT EMAIL <br /> 685 W. third Street sandy.huff@valero.com <br /> CONTACT MAILING CITY 1207 STATE 121. ZIP CODE <br /> Hanford I CA 93230 <br /> -PRIMARY- IV. EMERGENCY CONTACTS -SECONDARY- <br /> NAME 123• NAME 128• <br /> Ja tar Gill Don Marcetti <br /> TITLE 124• TITLE 129• <br /> Manager Area Manager <br /> BUSINESS PHONE 125. BUSINESS PHONE 130. <br /> 209 477-3111 209 601-2373 cell <br /> 24-HOUR PHONE 126. 24-HOUR PHONE 131. <br /> 510 713-1713 209 601-2373 <br /> PAGER# 127. PAGER# 132. <br /> ( ) ( ) <br /> ADDITIONAL LOCALLY COLLECTI-"D INFORMATION: 133. <br /> Billing Address: 685 W. Third Street, Hanford, CA 93230 <br /> Property Owner: Valero California Retail Company Phone No.: (559) 582-0241 <br /> 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 <br /> am familiar with the information submitte and believe the information is true,accurate,and complete. <br /> SIGNATURE OF OWNER/O ERAT R DES GN E REPRESENTATIVE DATE 134. NAME OF DOCUMENT PREPARER 135. <br /> ! /f Sandy Huff <br /> NAME OF SIGNER(print) U136• TITLE'OFSIGNER 13T <br /> Sandy Huff Compliance Coordinator <br /> UPCF Rev. (12/2007)-1/2 www.unidocs.org <br />