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NIFIED PROGRAM CONSOLIDATED M <br /> FACiIJTY INFORMATION <br /> BUSINESS OWNER/OPERATOR IDENTIFICATION <br /> Last Website Update: ® Page_ of_ <br /> I. IDENTIFICATION <br /> FACILITY IVU 12103 I RFOINNINO IIATF N/A 100 1 ENDING DATE N/A 101 <br /> BUSINESS NAME(Same as FACILITY NAME or DBA-Doine Business As) 3 BUSINESS PHONE 102 <br /> CEN CAL PLASTERING INC 209-858-9766 <br /> RI TVINFSS 1;1TF AnnRFSS 103 BUSINESS FAX <br /> 15300 S MCKINLEY AVE Not Collected <br /> BUSINESS SITE CITY 104 71P COnF 105 COUNTY 108 <br /> LATHROP CA 95330 SAN JOAOUIN <br /> DUN&BRADSTREET 106 PRIMARY SIC 107 PRIMARY NAICS 107s <br /> 8904/036499-5 1742 Not Collected <br /> RI ISTNFSS MAILTN6 ADDRFSS IORA <br /> BUSINESS MAILING CITY 108t STATE I Os ZIP CODE 108d <br /> BUSINESS OPERATOR NAME 109 BUSINESS OPERATOR PHONE 110 <br /> JEFF GANN 209-858-9766 <br /> 11. BUSINESS OWNER <br /> OWNERNAME(14) 1I1 I OWNFR PH0NPO91 112 <br /> JEFF GANN 209-858-9766 <br /> OWNFR MAILING ADDRESS 113 <br /> 15300 S MCKINLEY AVE <br /> OWNPR MAR MO CITY 114 STATE 115 Z1P CnnF. 116 <br /> LATHROP CA 95330 <br /> III. ENVIRONMENTAL CONTACT <br /> CONTACT NAME 117 1 CONTACT PHONE 118 <br /> SANDRA GRANT BROWN 209-858-9766 <br /> CONTACT MAILING ADDRESS 110 CONTACT EMAIL I 1 q <br /> sandra@cencalplastering.com <br /> CONTACT MAILING CITY 120 STATE 121 ZIP COOP 122 <br /> IV. EMERGENCY CONTACTS <br /> NAME JEFF GANN 123 NAME SANDRA GRANT BROWN 128 <br /> TITLE PRESIDENT 124 TITLE SAFETY COORDINATER 129 <br /> BUSINESS PHONE 209-858-9766 125 BUSINESS PHONE 209-858-9766 130 <br /> 24-HOUR PHONE 209-993-2280 126 74-1401IR PUONP 209-456-4170 131 <br /> PAOFR/CFI.I.k N/A 127 PAOFR/C:FLLd N/A 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 Administerting Agency's HMMP Compliance Website that I have personally examined and am familiar with the informaiton submitted and <br /> SIGNATURE OF OWNER/OPERATOR OR DESIGNATED REPRESENTATIVE I DATE 134 1 NAME OF DOCUMENT PREPARER 135 <br />