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Ah Ah <br /> NIFIED PROGRAM CONSOLIDATED FWM <br /> FACIIJTV INFORMATION <br /> BUSINESS OWNER/OPERATOR IDENTIFICATION <br /> Last Website Update: ® Page of.,__ <br /> L IDENTIFICATION <br /> FACR 1TV rna 5413 1 RFC.rNN1NC.nATF N/A 100 ENDING DATE N/A 101 <br /> BUSINESS NAME(Same as FACILITY NAME or DBA-Doina Business Asl 3 BUSINESS PHONE 102 <br /> CALIFORNIA CONCENTRATE CO 209-334-9112 <br /> RHCINFCC S1TF AnDRFPs 103 BUSINESS FAX <br /> 18678 N HWY 99 Not Collected <br /> BUSINESS SITE CITY 104 71P cnnF 105 COUNTY 108 <br /> ACAMPO CA 95220 SAN JOAQUIN <br /> DUN&BRADSTREET 106 PRIMARY SIC 107 PRIMARY NAICS 107a <br /> 09-623-4265 2033 Not Collected <br /> R1iSINF.9S MAII.1Nn ADDRF3R IOA <br /> 18678 N HWY 99 <br /> BUSINESS MAILING CITY 108t STATE I ng ZIP CODE 108d <br /> ACAMPO CA 95220 <br /> BUSINESS OPERATOR NAME 109 BUSINESS OPERATOR PHONE 110 <br /> ANDY ALEXANDER 209-334-9112 <br /> H. BUSINESS OWNER <br /> OWNERNAME(14) l l l OWNFR PHnNF(i 11 112 <br /> DENNIS ALEXANDER 209-368-3160 <br /> nWNFR MAILMn ADDRRRS 113 <br /> 21900 N DEVRIES <br /> OWNPR MAIL1N(I C1TV 114 STATE 115 ZIP CnnF 116 <br /> LODI CA 95240 <br /> III. ENVIRONMENTAL CONTACT <br /> CONTACT NAME 117 1 CONTACT PHONE 118 <br /> DOMINIC ALEXANDER 209-334-9112 <br /> CONTACT MAILING ADDRESS 110 CONTACT EMAIL 1 19a <br /> 18678 N HIGHWAY 99 N/A domtalexander@gmail.com <br /> CONTACT MAILING CITY 120 STATE 121171P CnDF 122 <br /> ACAMPO CA 95220 <br /> IV. EMERGENCY CONTACTS <br /> NAME ANDY ALEXANDER 123 NAME THOMAS ALEXANDER 128 <br /> TITLE VICE PRESIDENT 124 TITLE VICE PRESIDENT 129 <br /> BUSINESS PHONE 209-334-9112 125 BUSINESS PHONE 209-334-9112 130 <br /> 24-HOUR PHONE 209-712-2719 126 74-HnHR PHnNF 209-369-2680 131 <br /> PAnFR/CFl.l.a 209-712-2719 127 PAnFR/CFII # 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 OWNERIOPERATOR OR DESIGNATED REPRESENTATIVE I DATE 134 1 NAME OF DOCUMENT PREPARER 135 <br />