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F- . <br />Aak <br />UNIFIED PROGRAM CONSOLIDATED FORM <br />FACTLITV TNFnRMATTnN <br />BUSINESS OWNER/OPERATOR IDENTIFICATION <br />Last Website Update: ® Page_ of <br />1. IDENTIFICATION <br />FACTLITV TDO 14381 I <br />RFGTNNTNG DATE N/A 100 <br />ENDING DATE N/A 101 <br />BUSINESS NAME (Same as FACILITY NAME or DBA - Doine Business As) 3 <br />QUALITY AERO MAINTENANCE <br />BUSINESS PHONE 102 <br />209-366-1040 <br />RITSTNF.RR STIR ADDRFSR 103 <br />23987 N HWY 99 <br />BUSINESS FAX <br />Not Collected <br />BUSINESS SITE CITY 104 <br />ACAMPO <br />CA <br />71P CODF. 105 <br />95220 <br />COUNTY 108 <br />SAN JOAQUIN <br />DUN & BRADSTREET 106 <br />83-941-2061 <br />PRIMARY SIC 107 <br />4581 <br />PRIMARY NAICS 107 <br />Not Collected <br />RT TRINERS MA II .TNG ADDRESS 1 nRa <br />BUSINESS MAILING CITY 108t <br />STATE 1 ng <br />ZIP CODE 108d <br />BUSINESS OPERATOR NAME 109 <br />FRANK MADDEN <br />BUSINESS OPERATOR PHONE 110 <br />209-366-1040 <br />II. BUSINESS OWNER <br />OWNER NAME (14) 111 <br />FRANK MADDEN <br />1 OWNFR PTanNP. 051 112 <br />209-339-1127 <br />nWNFR MATI.ING ADDRFRR 113 <br />2981 HAZELWOOD WAY <br />nWNFR MATTING rJTV 114 <br />LODI <br />STATE 115 <br />CA <br />71P rnDF. 116 <br />95242 <br />III. ENVIRONMENTAL CONTACT <br />CONTACT NAME 117 <br />FRANK MADDEN <br />1 CONTACT PHONE 118 <br />209-366-1040 <br />CONTACT MAILING ADDRESS 110 <br />NA NA NA <br />CONTACT EMAIL i i 9a <br />qualityaero@gmail.com <br />CONTACT MAILING CITY 120 <br />NA <br />STATE 121171P <br />NA <br />(-.nDF 122 <br />NA <br />IV. EMERGENCY CONTACTS <br />NAME FRANK MADDEN 123 <br />NAME DEBBIE MADDEN 128 <br />TITLE OWNER 124 TITLE <br />SPOUSE 129 <br />BUSINESS PHONE 209-366-1040 125 BUSINESS <br />PHONE NA 130 <br />24-HOUR PHONE 209-642-5675 126 94-14ni <br />TR PH()NF 209-712-8440 131 <br />PAGER/CF.T.T.H 209-642-5675 127 1 PAGFR/CFIl.0 <br />209-712-8440 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 informs iton submitted and <br />SIGNATURE OF OWNER/OPERATOR OR DESIGNATED REPRESENTATIVE <br />DATE 134 <br />1 NAME OF DOCUMENT PREPARER 135 <br />