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,[,,BUS NESS OWNER/OPERATM IDENTIFICATION FORM Account#: 10350 <br /> I. IDENTIFICATION <br /> BUSINESS NAME (4) VALLEY FORKLIFT BUSINESS PHONE(5) 209-933-0206 <br /> SITE ADDRESS (6) 3131 E❑ FREMONT -1ST <br /> Street No. Direction Street Name Street T e I A�t/Bld Suite <br /> CITY (7) STOCKTON STATE(8)F— <br /> CA ZIP(9) 95205 <br /> DUN & (10) 06-248-5032 SIC CODE(4 DIGIT#) (11) 7359 <br /> BRADSTREET <br /> OPERA <br /> NAME TOR (12) MARK ANDRES OPERATOR PHONE(13) 209-933-0206 <br /> II. BUSINESS OWNER <br /> OWNER NAME(14) WHOLESALE EQUIPMENT OWNER PHONE(15) 559-268-6285 <br /> OWNER MAILING ADDRESS(16) 3183 GOLDEN STATE BLVD <br /> (If different from site address) <br /> CITY(17) FRESNO STATE(18) CA ZIP(19) 93725 <br /> III. ENVIRONMENTAL CONTACT <br /> CONTACT NAME(20) KEN RATHE CONTACT PHONE(2 1) 209-933-0206 <br /> MAILING ADDRESS(22) IF <br /> (If different from business <br /> mailing address) <br /> S[ree[No. Direction Street Name Street Type A t/Bld /Suite <br /> CITY(23) F I STATE(24) El ZIP <br /> (25) <br /> Primary IV. EMERGENCY CONTACTS Secondary <br /> NAME(26) KEN RATHE NAME(31) MARK ANDRES <br /> TITLE(27) BRANCH MANAGER TITLE(32) SERVICE MANAGER <br /> BUSINESS PHONE(28) 209-933-0206 BUSINESS PHONE(33) 209-933-0206 <br /> 24-HOUR PHONE(29) 209-992-5044 24-HOUR PHONE(34) 209-551-0273 <br /> PAGER #(30) AFTER HR PAGER/VOICE PAGER#(35) AFTER HR PAGER/VOICE <br /> EXTREMELY HAZARDOUS SUBSTANCES (EHS) <br /> ON-SITE EHS (36) NO If yes,and above Threshold Planning Quantities,attach a sheet of paper with a general <br /> description of the process and principle equipment involving the EHS. <br /> ADDITIONAL LOCALLY COLLECTED INFORMATION(37) Provide information requested on the back of this form <br /> NAME OF DOCUMENT PREPARER (38) JULIE OROSCO <br /> NAME OF OWNER/OPERATOR(39) DERRY HUDSON DATE E(40) <br /> DATE REC'D: 10/26/06 <br />