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GEIYED <br /> BUSINESS OWNER/OPERATOR IDENTIFICATION FO SIDE 1 <br /> BEGINNING DATE(1) pb/ I. IDENTIFICATION ( PAGE I OFA <br /> BUSINESS NAME (4) SANJOAQUINC UN <br /> VAGcE �kKL/Fj BusIN <br /> SITE ADDRESS (6) 3 ) 3 i <br /> Street No. Direction Street Name Street Type A t/Bld /Suite <br /> CITY (7) S�oCKTU ! STATE(8)® ZIP(9) 95105 <br /> DUN& (10) IC CODE(4DIGIT#)(11) <br /> BRADSTREET / <br /> OPERATOR (12) r OPERATOR PHONE(13) <br /> NAME <br /> II. BUSINESS OWNER <br /> OWNER NAME(14) AC OWNER PHONE(15) <br /> OWNER ADDRESS (16) s, Q <br /> (If different from Entries#6 or#41) 3 3 �GJ-6 //f (E UL VQ <br /> CITY(17) Fers _`o STATE(I8) FM <br /> ZIP(19) /)s�;��s <br /> / III. ENVIRONMENTAL CONTACT 7J <br /> CONTACT NAME(20) CONTACT PHONE(21) <br /> (�aq 933 -o;1clo <br /> CONTACT ADDRESS(22) <br /> (If different from Entries#6 IF I � 3 <br /> or#4I) Street No. Direction Street NameStreetType Apt/Bldg/Suite <br /> CITY(23) F I STATE(24) ❑ ZIP(25) <br /> Primary IV. EMERGENCY CONTACTS Secondary <br /> NAME(26) NAME(31) <br /> A/? ©0 -kr S 6-7Z lelgr' 0/9 <br /> TITLE(27) fi7j4jj A TITLE(32) P CC Nj lqy 'j � <br /> BUSINESS PHONE(28) G1 BUSINESS PHONE(33) <br /> 24-HOUR PHONE(29) 24-HOUR PHONE(34) C <br /> (After Business Hours) (-/�� ) � r �/C (After Business Hours) ( / �b) 7 1 < <br /> PAGER#(30) PAGER#(35) <br /> 4rT� /fCup Q -�I t'orc'e� 4rr—tE'/1 NtYcr2 p�6e����cE <br /> �EMELY HAZARDOUS SUBSTANCES (EHS) <br /> ON-SITE EHS (36) p YES NO If yes,and above Threshold Quantities,attach a sheet of paper with a general <br /> description of the process and principle equipment. <br /> ADDITIONAL LOCALLY COLLECTED INFORMATION(37) Provide information requested on the back of this form <br /> NAME OF DOCUMENT PREPARER (38) OZ �S, n/ <br /> DATE(40) <br /> NAME OF OWNER/OPERATOR(39) n IS r E <br /> en io �2 <br /> SIC 12/00 <br />