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UNIFIED PROGRAM CONSOLIDATED FORM <br /> FACMITY INFORMATION <br /> BUSINESS OWNER/OPERATOR IDENTIFICATION <br /> Page of_ <br /> Last Website Update: <br /> L IDENTIFICATION <br /> 1 BEGINNING DATE N/A 100 ENDING DATE N/A 101 <br /> FACTI.TTV IM 6985 <br /> BUSINESS NAME(Same as FACILITY NAME or DBA-Doing Business As) 3 BUSINESS PHONE 102 <br /> OFF ROAD ENTERPRISES 209-931-1170 <br /> 1021 <br /> RT JUNTFRS STTF AT)DRFSR 103 BUSINESS FAX <br /> 2953 CHERRYLAND AVE #B Not Collected <br /> BUSINESS SITE CITY 104 7iP nnF 105 COUNTY 108 <br /> STOCKTON I r. <br /> CA 95215-2233 SAN JOAOUIN <br /> DUN&BRADSTREET 106 PRIMARY SIC 107 PRIMARY NAICS 107, <br /> 112720313 7549 Not Collected <br /> Inn <br /> RTTRTNF.SS MATTING AnnRF.RB <br /> BUSINESS MAILING CITY 108 STATE InR ZIP CODE 108d <br /> BUSINESS OPERATOR NAME 109 BUSINESS OPERATOR PHONE 110 <br /> WADE MARTIN 209-931-1170 <br /> II. BUSINESS OWNER <br /> OWNERNAME(14) 111 GWNF.R PTIONF.G sl 112 <br /> WADE MARTIN (209)969-7178 <br /> 113 <br /> nWNFR MATTING AnnRFRR <br /> 3261 CHERRYLAND AVE. <br /> OW MATT Ma CITY 114 STATE 115 ZIP CnnF 116 <br /> STOCKTON CA 95215 <br /> M. ENVIRONMENTAL CONTACT <br /> CONTACTNAME 117 CONTACTPHONE 118 <br /> WADE MARTIN 209-931-1170 <br /> CONTACT MAILING ADDRESS Ila CONTACT EMAIL 11% <br /> 3261 CHERRYLAND AVE w4wdmartin@aol.com <br /> CONTACT MAILING CITY 120 STATE 121 7TP CODF 122 <br /> STOCKTON CAL 95215 <br /> IV. EMERGENCY CONTACTS <br /> NAME WADE MARTIN 123 NAME N/A 128 <br /> TITLE OWNER 124 TITLE N/A 129 <br /> BUSINESS PHONE 209-931-1170 125 BUSINESS PHONE N/A 130 <br /> 24-HOUR PHONE 209-969-7178 126 ?4-140TTR PT-TnNF. N/A 131 <br /> PAGFRICFT.1.# N/A 127 PAGFR/CFT.T.* 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 I have personally examined and am familiar with the informaiton submitted and <br /> SIGNATURE OF OWNER/OPERATOR OR DESIGNATED REPRESENTATIVE I DATE 134 1 NAME OF DOCUMENT PREPAR.ER 135 <br />