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RFCE_I ) <br /> %�IFIED PROGRAM CONSOLIDATED FO" <br /> — 5 MCILITY INFORMATION <br /> BUSINESS OWNER/OPERATOR IDIf� y� <br /> _.... _._ <br /> _e_ <br /> h IDENTIFICATION <br /> FACILITY ID# F Hli [ H I <br /> A 178 EGINNING DATE 100 ENDING PATE 101 <br /> 1101108 12/31/08 <br /> BUSINESS NAME(Same as FACILITY NAME orDBA-Doing Business As) 3 BUSINESS PHONE 102 <br /> 7-Eleven#20632 209-952-3543 <br /> BUSINESS SITE ADDRESS <br /> 103 <br /> 4627 Da Vinci Dr. <br /> CITY 164 <br /> Stockton CA z1P CODE los <br /> 95207 <br /> DUN 8 BRADSTREET 106 SIC CODE(4 digit#) 107 <br /> 00-734-7602 5541 <br /> COUNTY <br /> toe <br /> San Joaquin <br /> BUSINESS OPERATOR NAME los BUSINESS OPERATOR PHONE 110 <br /> Manjit& Gurpal Grewal209-952-3543 <br /> _. <br /> I1. BUSINESS'OWNER <br /> OWNER NAME 111 OWNER PHONE 112 <br /> 7-Eleven, Inc. 916-463-6776 <br /> OWNER MAILING ADDRESS 113 <br /> P.O. Box 711 Attn: Gasoline Acctg <br /> CITY 114 STATE 115 ZIP CODE 116 <br /> Dallas TX 75221-0711 <br /> _.... III. ENVIRONMENTAL CONTACT ...._.......... __.._.._.__....... . <br /> CONTACT NAME 117 CONTACT PHONE 118 <br /> Ian Moorhead 916-463-6776 <br /> CONTACT MAILING ADDRESS 119 <br /> P.O. Box 711 Attn: Gasoline Acctg <br /> CITY 120 STATE 121 ZIP CODE 122 <br /> Dallas TX 75221-0711 <br /> -PRIMARY- 'IV. EMERGENCY CONTACTS -SECONDARY- <br /> NAME 123 NAME 128 <br /> Manjit Grewal 7-Eleven Emergency Dispatch I <br /> TITLE 124 TITLE 129 <br /> Franchisee Emergency Service <br /> BUSINESS PHONE 125 BUSINESS PHONE 130 <br /> 209-952-3543 800-828-0711 <br /> 24-HOUR PHONE 126 24-HOUR PHONE 131 <br /> 1-800-828-0711 <br /> PAGER# 127 PAGER# 132 <br /> ADDITIONAL LOCALLY COLLECTED INFORMATION: <br /> Certification: Based on my inquiry of those individuals responsible for obtaining the information, I certify under penalty of law that I have personally <br /> examined and am familiar with the information submitted and believe the information is true,accurate,and complete. <br /> SIGNATURE OF OWNERIOPERATOR OR DESIGNATED REPRESENTATIVE DATES 134 NAME OF DOCUMENT PREPARER 135 <br /> 4L/zS�P Rachel Rodriguez <br /> NAME OF SIGNER(print) 136 TITLE OF SIGNER 137 <br /> Ian Moorhead Region Gasoline Environmental Compliance Manager <br /> UPCF (1199 revised) HMP 2(Back)Instructions OES FORM 2730 <br /> (1199) <br />