Laserfiche WebLink
BUSINESS OWNER/OPERATOR IDENTIFICATION PA � : SIDE 1 <br /> CALENDAR YEAR BEGINNING (1) 1/15/2003 ENDING (2) 1 1/15/2004j JAN 13 (2fl!33GE 1 OF <br /> BUSINESS NAME (4) Nick's 76#261119 209-983-0381 <br /> SITE ADDRESS (6) 16500 Louise Ave. <br /> Street No. Direction Street Name Street Type Apt/Bldg/Suite <br /> CITY M Lathrop STATE (g) CA ZIP (9) 95330 <br /> DUN& (to) 04-8564975 SIC CODE (4 DIGIT#) (11) 5541 <br /> BRADSTREET <br /> OPERATOR (12) Nasser Arbabian OPERATOR PHONE (13) 209-983-0381 <br /> NAME <br /> OWNER INFORMATION <br /> OWNER NAME (14) Nasser Arbabian OWNER PHONE(15) 209-983-0381 <br /> OWNER MAILING ADDRESS (16) 904 Kathrine Way <br /> (if different from site addrgss) <br /> CITY (17) Fc%llrop, CA 95209 STATE (18) CA ZIP (19) 1 95330 <br /> ENVIRONMENTAL CONTACT <br /> CONTACT NAME (20) Janette Thompson CONTACT PHONE(21) 925-277-2404 <br /> MAILING ADDRESS (22) 2000 Crow Canyon Pl. Suite 400 <br /> (if different from site address) <br /> Street No. Direction Street Name Street Type A t/Bld /Suite <br /> CITY (23) San Ramon STATE(24) CA ZIP (25) 94583 <br /> Primary EMERGENCY CONTACTS Secondary <br /> NAME: (26) Nasser (Nick) Arbabian NAME: (31) James Young <br /> TITLE: (27) Dealer TITLE: (32) Retail Terr. Supv. <br /> BUSINESS PHONE: (28) 209-983-0381 BUSINESS PHONE: (33) 925-277-2478 <br /> 24-HOUR PHONE: (29) 209-478-9583 24-HOUR PHONE: (34) 916-688-3449 <br /> PAGER#: (30) PAGER#: (35) <br /> ACUTELY HAZARDOUS MATERIALS (AM <br /> ON SITE AHM (36)I'I,� QNo If yes,and above Threshold Planning Quantities, attach a sheet of paper with a general <br /> 1 description of the process and principal equipment. <br /> ADDITIONAL LOCALLY COLLECTED INFORMATION (37) Provide information requested on the back of this form <br /> Name of Document Preparer(38) RHL Design Group, Inc. <br /> Name of Owner/Operator(39) 10 Date (40) X I /17 how 'L <br /> SIC 12/99 <br />