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L.L., <br /> FIED PROGRAM CONSOLIDATED FORM <br /> FACILITY INFORMATION <br /> BUSINESS OWNER/OPERATOR IDENTIFICATION <br /> Modification Date:01/17/2012 <br /> Last Website Update: 01%14/2qj Page_ of <br /> I. IDENTIFICATION <br /> FACILITY ID# 12092 CA Zto y LCe 1 I BEGINNING DATE N/A 100 ENDING DATE N/A 101 <br /> BUSINESS NAME(Same as FACILITY NAME or DBA-Doing Business As) 3 BUSINESS PHONE 102 <br /> CARL'S JR#7481 209.476-1091 102, <br /> BUSINESS SITE ADDRESS 103 BUSINESS FAX <br /> 3205 E HAMMER LN Not Collected <br /> BUSINESS SITE CITY 104 ZIP CODE 105 COUNTY 108 <br /> STOCKTON CA 95209 SAN JOAQUIN <br /> DUN&BRADSTREET 106 PRIMARY SIC 107 PRIMARY NAICS 107a <br /> 02-783-1361 5812 Not Collected <br /> BUSINESS MAILING ADDRESS 108. <br /> 2643 3RD ST <br /> BUSINESS MAILING CITY 1081 STATE 108c ZIP CODE 108d <br /> LIVERMORE CA 94550 <br /> BUSINESS OPERATOR NAME 109 BUSINESS OPERATOR PHONE 110 <br /> WOMAR INC. 925-292-1024 <br /> 11. BUSINESS OWNER <br /> OWNER NAME(14) 11 I OWNER PHONE(15) 112 <br /> WOMAR INC 925-292-1024 <br /> OWNER MAILING ADDRESS 113 <br /> 2643 3RD.ST. <br /> OWNER MAILING CITY 114 STATE 1ISZIPCODE 116 <br /> LIVERMORE CA 94550 <br /> III, ENVIRONMENTAL CONTACT <br /> CONTACT NAME 117 CONTACT PHONE 118 <br /> ROSE LARKIN 209-327.9478 <br /> CONTACT MAILING ADDRESS 119 CONTACT EMAIL 11 an <br /> 2643 3RD ST 5larkns0cleamire.net <br /> CONTACT MAILING CITY 120 STATE 121 ZIP CODE 122 <br /> LIVERMORE CA 94550 <br /> IV. EMERGENCY CONTACTS <br /> NAME 123 NAME ff__ 128 <br /> CKISSY'SABO '�� WON W <br /> TITLE 124 TITLE C e—r29 <br /> GENERAL MANAGER Nr�9 <br /> BUSINESS PHONE 209-476-1091 125 BUSINESS PHONE 925-292-1024 130 <br /> 24-HOUR PHONE 209-712-1654 126 24-HOUR PHONE1 089 349, 31 <br /> PAGER/CELL# NA 127 PAGER/CELL# NA 132 <br /> ADDITIONAL LOCALLY COLLECTED INFORMATION: 133 <br /> COMPLETE PAGE 2 OF BUSINESS OWNER/OPERATOR IDENTIFICATION <br /> Certification: Based on my inquiry of those individuals responsible for obtaining the information,I certify under penalty of law by signing below or certifying by the <br /> established processes on the Adminisrerting Agency's HMMP Compliance Website that I have personally examined and am familiar with the informaiton submitted and <br /> believe the information is true,accurate,and complete. <br /> SIGNATURE OF OWNER/OPERATOR OR DESIGNATED REPRESENTATIVE DATE 134 1 NAME OF DOCUMENT PREPARER 135 <br /> NAME OF SIGNER(print) 136 ITTLE OF SIGNER 137 <br /> UPCF Rev. 12/2007 <br />