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UPDATE PENDING <br /> BUSINESS OWNER/OPERATOR IDENTIFICATION FORM Account#: X372 <br /> I. IDENTIFICATION <br /> USINESS NAME (4) OCKEFORD SHELL BUSINESS PHONE(5) 09-727-54 <br /> TE ADDRESS (6) v" IVED <br /> 4-Z- TATE ROUTE 88 <br /> Street o. rzection Street Name reef ype 2008 <br /> ITY (7) OCKEFORD STATE(8)F1 ZIP(9) 5237 OFFIC SAN JCgQU <br /> COUNTY <br /> UN& (10) SIC CODE(4 DIGIT#)(11) NCYSERVCES <br /> 1L.ADSTREEr MAIN STREET <br /> PERATOR (12) OPERATOR PHONE(13) <br /> AME IMOHAMMAD AFZAL 16-432-9698 <br /> II. BUSINESS OWNER <br /> WNER NAME(14) OWER ENERGY GROUP OWNER PHONE(15) 10-878-8428 <br /> WNER ADDRESS (16) <br /> different from Entries#6 or#41 1983 WEST 190TH STREET <br /> TY(17) ORRANCE STATE(18) FTI ZIP(19) <br /> 111. ENVIRONMENTAL CONTACT <br /> :)NTACC NAME(20) MOHAMMAD AFZAL CONTACT PHONE(2 1) 16-432-9691 <br /> JNTACT ADDRESS(22) <br /> 'different from Entries#6 759 RUFFLE T <br /> #41) :1� — <br /> 1 0. Ircctio11 beet Name .treet Type one <br /> 1'IY(23) STATE(24) A ZIP(25) <br /> ANTELOPE 5843 <br /> primary IV. EMERGENCY CONTACTS <br /> Secondary <br /> NAME 00 OHAMMAD SIDDIQUE <br /> 4AME(261 OHAMMAD AFZAL <br /> TITLE(32) SST MANAGER <br /> r1TLE(27) ANAGER <br /> BUSINESS PHONF.(33) 09-727-5442 <br /> BUSINESS PHONE(28) 09-727-5442 .t7= _ <br /> 24-HOUR PHONE(34) 162`2 <br /> 2-9698 (After Business Hours) 1r <br /> 16.43 <br /> 24-HOUR PHONE(29) <br /> (After Business Hours) PAGER#(35) )p I <br /> PAGER#(30) NIA '1 <br /> Y HAZARDOUS SUBSTANCES (EHS) wlth a <br /> EXTREMELY uanti6es,at ach a sheet of paper the EI1S <br /> idly, <br /> yes,and above Threshdd Q riociple equ"m"ot involving �---� <br /> description of the Process and p T1s torm <br /> ON-SITE EHS (36) O sted on the 2nd f <br /> AUUIC1pNAL LOCM-LY <br /> COLLECTED <br /> INFORMATION(37) Provide information reque,' <br /> NAME OF DOCUMENT PREPARER(38) <br /> OHAMMAD AFZAL <br /> DATE(`u1) <br /> £0011 ,LHYN QOOd OHOd}I0011 0910 LZL 60Z 1 YVd L£:01 £OOZ/01/Zt <br />