Laserfiche WebLink
BUSINESS OWNER/OPERAT DENTIFiCATION FORM Account#: 12068 <br /> 1. IDENTIFICATION <br /> BUSINESS NAME (4) JAGUAR EXPRESS BUSINESS PHONE(5) 209-460-0877 <br /> SITE ADDRESS (6) 3798 IF HWY 99 <br /> Street No. Direction Street Name Street Type A t/Blda/Suitc <br /> CITY (7) STOCKTON STATE(8)F- <br /> CA ZIP(9) 95215 <br /> DUN& (10)087920117 SIC CODE(4 DIGIT#)(11) 4842 <br /> BRADSTREET <br /> OPERATOR (12) LARRY TOONE OPERATOR PHONE(13) 209-460-0877 <br /> NAME <br /> II.BUSINESS OWNER <br /> OWNER NAME(14) LARRY TOONE OWNER PHONE(15) 209-239-7607 <br /> OWNER MAILING ADDRESS(16) 1535 LIVERPOOL CT. <br /> (If different from site address) <br /> CITY(17) MANTECA STATE(18) CA ZIP(19) 95336 <br /> III. ENVIRONMENTAL CONTACT <br /> CONTACT NAME(20) LARRY TOONE CONTACT PHONE(21) 209-460-0877 <br /> MAB-ING ADDRESS (22) <br /> (If different from business 1535 ❑ LIVERPOOL CT CT <br /> mailing address) <br /> Street No. Direction Street Name Street Type A t/Bld Suite <br /> CITY(23) FNTECA STATE(24) E <br /> ZIP(25) 95336 <br /> Primary IV. EMERGENCY CONTACTS Secondary <br /> NAME(26) LARRY TOONE NAME(3 1)1JEROME HERLICY <br /> TITLE(27) PRESIDENT TITTLE(32) MECHANIC <br /> BUSINESS PHONE(28) 209-460-0877 BUSINESS PHONE(33) 209-460-0877 <br /> 24-HOUR PHONE(29) 206-603-0275 24-HOUR PHONE(34) 209-483-1578 <br /> PAGER#(30) NA PAGER#(35) NA <br /> EXTREMELY HAZARDOUS SUBSTANCES (EHS) <br /> ON-SITE EHS (36) NO If yes,and above Threshold Planning Quantities,attach a sheet of paper with a general <br /> description of the process and principle equipment involving the EHS. <br /> ADDITIONAL LOCALLY COLLECTED INFORMATION(37) Provide information requested on the back of this form <br /> NAME OF DOCUMENT PREPARER(38) LARRY TOONE <br /> NAME OF OWNER/OPERATOR(39) LARRY TOONE DATE(40) <br /> DATE REC'D: 5/5/04 <br />