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rGo G P Luu9 <br /> BUSINESS�OWNEWOPERAT(,—j� IDTJNTIFICATiON F NIT Account#: 10350 <br /> vs <br /> 1. IDENTIFICATION <br /> BUSINESS NAME (4) VALLEY FORKLIFT BUSINESS PHONE(5) 209-933-0206 <br /> SITE ADDRESS (6) 3131E❑ FREMONT ST <br /> Street No. Direction Street Name SVeet T e A t/Bld Suite <br /> CITY (7) STOCKTON STATE(8) CA ZIP(9) 95205 <br /> DUN& (10) 06-248-5032 SIC CODE(4 DIGIT#)(I1) 7359 <br /> BRADSTREET <br /> OPERATOR (12) OPERATOR PHONE(13) <br /> NAME LARRY COWGER 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 ZEP(19) 93725 <br /> III. ENVIRONMENTAL CONTACT <br /> CONTACT NAME(20) LARRY COWGER CONTACT PHONE(2 1) 209-933-0206 <br /> MAILING ADDRESS ❑ �� <br /> (If different from business <br /> mailing address) <br /> Street No. Direction Street Name StreetT e A t/Bld Suiie <br /> CITY(23) F I STATE(24) El ZIP(25) <br /> Primary IV. EMERGENCY CONTACTS Se ondary <br /> NAME(26) LARRY COWGER NAME(31)[KEN RATHE <br /> TITLE(27) SERVICE MANAGER I TITLE(32) SALES MANAGER <br /> BUSINESS PHONE(28) 209-933-0206 BUSINESS PHONE(33) 209-933-0206 <br /> 24-HOUR PHONE(29) 209-321-6200 24-HOUR PHONE(34) 209-992-5044 <br /> PAGER#(30) AFTER HR PAGERNOICE PAGER#(35) AFTER HR PAGERNOICE <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) LARRY COWGER DATE(40) <br /> DATE REC'D: 2/27/04 <br />