Laserfiche WebLink
RECEI�D <br /> APR 7 <br /> UNIFIED PROGRAM CONSOLIDATED FORM <br /> FACILITY INFORMATION FF�C SANJQAQU�N <br /> BUSINESS OWNER/OPERATOR(03/11/200910:55:28 IDENTIFICATIO SQFEMER�NOy N <br /> jjg <br /> Page_ of_ ICQ <br /> 1. IDENTIFICATION <br /> FACILITY ID# 9343 IJBEGINNING DATE N/A 100 ENDING DATE N/A 101 <br /> BUSINESS NAME(Same as FACILITY NAME or DBA-Doing Btuiness As) 3 BUSINESS PHONE 102 <br /> EDDIE'S PIZZA CAFE(ELDORADO) 209-462-4735 <br /> BUSINESS SITE ADDRESS I(D I BUSINESS FAX 102a <br /> 1419 S ELDORADO Not Collected <br /> BUSINESS SITE CITYI04 ZIP CODE 105 COUNTY 108 <br /> STOCKTON CA 95206 SAN JOAQUIN <br /> DUN&BRADSTREET 106 PRIMARY SIC HT7 PRIMARY NA1CS 107a <br /> N/A N/A Not Collected <br /> BUSINESS MAILING ADDRESS I08a <br /> P.O.BOX 6098 <br /> BUSINESS MAILING CITY 108t STATE I08c ZIP CODE 108d <br /> STOCKTON CA 95206-0089 <br /> BUSINESS OPERATOR NAME 109 BUSINESS OPERATOR PHONE 110 <br /> VICTOR ESALOO 209-4624735 <br /> D. BUSINESS OWNER <br /> OWNER NAME(14) 111 1 OWNER PHONE(15) 112 <br /> VICTOR ESALOO 209-462-4735 <br /> OWNER MAILING ADDRESS 113 <br /> P.O.BOX 6089 <br /> OWNER MAILING CITY 114 STATE 115 ZIP CODE 116 <br /> STOCKTON CA 95206-0089 <br /> DI. ENVIRONMENTAL CONTACT <br /> CONTACT NAME 117 CONTACI PHONE IIB <br /> VICTOR ESALOO 209.462-4735 <br /> CONTACT MAILING ADDRESS 119 CONTACT EMAIL 119a <br /> blpizza@sbcglobalmet <br /> CONTACT MAILING CITY 120 STATE 12l ZIP CODE 122 <br /> IV. EMERGENCY CONTACTS <br /> AME VICTOR ESALOO 123 NAME STEVE CLAUSEN 128 <br /> TITLE 124 TITLE 129 <br /> PRESIDENT VICE PRESIDENT <br /> BUSINESS PHONE 209-462-4735 125 BUSINESS PHONE 209462-4735 130 <br /> 24-HOUR PHONE 408-309-2544 126 24-HOUR PHONE 209-271-6285 131 <br /> PAGER# N/A 127 PAGER# 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 pcnalry,of law by signing below or certifying by the <br /> established processes on the Adminislerting Ageney's"MMP Complimme Website that I have personally examined and am familiar with the information submitted and <br /> believe the information is true,accurate,and complete, <br /> SIGNATURE OF OWNER/OPERATOR OR DESIGNATED REPRESENTATIVE DATE 134 1 NAME OF DOCUMENT PREPARER 135 <br /> NAME OF SIGNER(print) 136 rITLE OF SIGNER 137 <br /> UPCF(Rev.12/2007) <br />