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rBUSINESS OWNED, 1DFN I IIS IC 111 DN F ORNI a Account#: 10350 <br /> I. IDENTIFICATION <br /> BUSINESS NAME (4) VALLEY FORKLIFT BUSINESS PHONE(5) 209-933-0206 <br /> SITE ADDRESS (6) 3131 7FIREMONT ST �� <br /> Street No. Direction Street Name Street T e A t/Bld Suite <br /> CITY (7) STOCKTON I STATE(8) CA ZIP(9) 95205 <br /> DUN& (10)06-248-5032 SIC CODE(4 DIGIT#)(11) 7359 <br /> BRADSTREET <br /> OPERATOR (12) MARK ANDRES OPERATOR PHONE(13) 209-933-0206 <br /> NAME <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(ls> CA ZIP(19) 93725 <br /> III. ENVIRONMENTAL CONTACT <br /> CONTACT NAME(20) MERK ANDRES CONTACT PHONE(21) 209-933-0206 <br /> MAU-ING ADDRESS(22) <br /> (If different from business IF I <br /> mailing address) <br /> Street No. Direction Street Name Street T e A t/Bld Suite <br /> CITY(23) F :1 STATE(24) E ZIP(25) <br /> Primary IV. EMERGENCY CONTACTS Secondary <br /> NAME(26) MARK ANDRES NAME(3 1) KEN RATHE <br /> TITLE(27) SERVICE MANAGER TITLE(32) SALES MANAGER <br /> BUSINESS PHONE(28) 209-933-0206 BUSINESS PHONE(33) 209-933-0206 <br /> 24-HOUR PHONE(29) 209-551-0273 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) NQ 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) MARK ANDRES DATE(40) <br /> DATE REC'D: 2/27/04 <br />