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ïż½NwtFIED PROGRAM CONSOLIDATED FORM <br /> FACILITY INFORMATION <br /> BUSINESS OWNER/OPERATOR IDENTIFICATION <br /> Modification Date:01/12/2010 <br /> Last Website Update: 1/24/2008 Page_ of <br /> I. IDENTIFICATION <br /> FACILITY ID# 6985 1 1 BEGINNING DATE N/A 100 ENDING DATE N/A 101 <br /> BUSINESS NAME(Same as FACILITY NAME or DBA-Doing Business As) 3 BUSINESS PHONE 102 <br /> OFF ROAD ENTERPRISES 209-931-1170 <br /> BUSINESS SITE ADDRESS 103 1 BUSINESS FAX <br /> 2953 CHERRYLAND AVE #B Not Collected <br /> BUSINESS SITE CITY 104 ZIP CODE 105 COUNTY 108 <br /> STOCKTON CA 95215-2233 SAN JOAQUIN <br /> DUN&BRADSTREET 106 PRIMARY SIC 107 PRIMARY NAICS 107 <br /> 112720313 7549 Not Collected <br /> BUSINESS MAILING ADDRESS 108 <br /> BUSINESS MAILING CITY 108t STATE 108 ZIP CODE I 08 <br /> BUSINESS OPERATOR NAME 109 BUSINESS OPERATOR PHONE 110 <br /> WADE MARTIN 209-931-1170 <br /> II. BUSINESS OWNER <br /> OWNER NAME(14) 111 I OWNER PHONE(15) 112 <br /> WADE MARTIN (209)969-7178 <br /> OWNER MAILING ADDRESS 113 <br /> 3261 CHERRYLAND AVE. <br /> OWNER MAILING CITY 114 STATE 115ZIP CODE 116 <br /> STOCKTON CA 95215 <br /> III. ENVIRONMENTAL CONTACT <br /> CONTACT NAME 117 CONTACT PHONE 118 <br /> WADE MARTIN 209-931.1170 <br /> CONTACT MAILING ADDRESS 119 CONTACT EMAIL 119 <br /> 3261 CHERRYLAND AVE w4wdmartin@ao1.com <br /> CONTACT MAILING CITY 120 STATE 121 ZIP CODE 122 <br /> STOCKTON CAL 95215 <br /> IV. EMERGENCY CONTACTS <br /> NAME WADE MARTIN 123 NAME N/A 128 <br /> TITLE OWNER N/A 124 TITLE 129 <br /> BUSINESS PHONE 209-931-1170 125 BUSINESS PHONE N/A 130 <br /> 24-HOUR PHONE 209-9694178 126 24-HOUR PHONE N/A 131 <br /> PAGER/CELL# N/A 127 PAGER/CELL# N/A 132 <br /> ADDITIONAL LOCALLY COLLECTED INFORMATION: 133 <br /> COMPLETE PAGE 2 OF BUSINESS OWNER/OPERATOR IDENTIFICATION <br /> Certification: Based on my inquiry of those individuals responsible for obtaining the information,I certify under penalty of law by signing below or certifying by the <br /> established processes on the Administerting Agency's HMMP Compliance Website that 1 have personally examined and am familiar with the iNbrmaiton submitted and <br /> believe the information is one.accurate,and complete. <br /> SIGNATURE OF OWNER/OPERATOR OR DESIGNATED REPRESENTATIVE DATE 134 NAME OF DOCUMENT PREPARER 135 <br /> NAME OF SIGNER(print) 136 TrrLEOFSIGNER 137 <br /> UPC:F Rev.12/2007/ <br />