Laserfiche WebLink
3USINESS OWNER/OPERATOR 117ENTIFICATION FORM ro F4ccountht: <br /> 936 <br /> 1. IDENTIFICATION <br /> BUSINESS NAME (4) ACK IN THE BO(X�#3408 BUSINESS PHONE(5) 09-943-2157 <br /> SITE ADDRESS (6) 989 WY 99 � <br /> Street No. lir—echon tree[Name treet <br /> ype ApU Idg/ mte <br /> CITY (7) STOCKTON STATE(8) A7 ZIP(9) H215 <br /> DUN& (10) SIC CODE(4 DIGIT#)(I1) <br /> BRADSTREET 4-211-7200 812 , <br /> OPERATOR (12) ARRISMANAGEMENT, OPERATOR PHONE(13) 10-792-3393 <br /> NAME INC. <br /> II.BUSINESS OWNER <br /> OWNER NAME(14) ACK IN THE BOX INC OWNER PHONE(15) 10-792-3393 —� N <br /> OWNER MAILING ADDRESS(16) 550 MOWRY AVE SUITE 301 <br /> (If different from site address) <br /> 0ffY (17) REMONT STATE(18) CA ZIP('9) <br /> 4538 <br /> III. ENVIRONMENTAL CONTACT <br /> CONTACT'NAME(20) ERESA HALE CONTACT PHONE(2 1) 10-792-3393 <br /> MAILING ADDRESS(22) ED' � �� <br /> (If different from business 550 OWRY VE UITE 301 <br /> mailing address) <br /> Feet o. trecuon trees Name trees ype Apt/ Idg/ uite <br /> CITY (23) REMONT STATE(24) ZIP(25) <br /> CA 2123-1516 <br /> Primary IV. EMERGENCY CONTACTS Secondary <br /> N AM F_(26) NAME(3 1) <br /> FERESA HALE ARCELA ROGUE <br /> TI"ITE(27) TITLE(32) <br /> AREA MGR GR <br /> BUSINESS PHONE(28) BUSINESS PHONE(33) <br /> 209-943.2157 209-943-2157 <br /> 24-HOIJR PHONE(29) 209-640-1298 24-HOUR PHONE(34) 209-640-1298 <br /> PAGER #(30) NSA PAGER#(35) /A <br /> � EXTREMELY HAZARDOUS SUBSTANCES (EHS) <br /> CIN'-SITE EHS (36) It 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) RIYANKA SETHI <br /> NAME OF OWNER/OPERATOR(39) NIL YADAV DATE(40) <br /> DATE RECD: 9/23/08 <br /> BUSINESS OWNER/OPERATOR IDENTIFICATION PAGE Page 2 <br /> BUSINESS MAILING AND BILLING INFORMATION <br /> ]AILING ADDRESS(41) <br /> If different from Site Address, <br />