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LES 2 e 6% <br />I. IDENTIFICATION <br />BUSINESS NAME (4) RIPON FARM SERVICE BUSINESS PHONE (5) 209-599-2188 <br />SITE ADDRESS (6) <br />99 FRONTAGE <br />CITY (7) RIPON STATE (8) FTI <br />ZIP (9) r <br />DUN & (10) 044296283 SIC CODE (4 DIGIT #) (11) Lr <br />BRADSTREET L <br />OPERATOR (12) BUD DEN OUDEN OPERATOR PHONE (13)N/A <br />NAME <br />II. <br />OWNER NAME (14) BUD DEN OUDEN <br />OWNER MAILING ADDRESS (16) O. BOX 806 <br />(If different from site address) <br />CITY (17) IDTUn%T <br />CONTACT NAME (20) 1 <br />MAILING ADDRESS (22) <br />(If different from business <br />mailing address) <br />CITY (23) F_ <br />VAN LAAR <br />NAME (26) IDUSTY VAN LAAR <br />TITLE (27) OPERATIONS MANAGER <br />BUSINESS PHONE (28) 209-599-2188 <br />24-HOUR PHONE (29) 209-575-1544 <br />PAGER # (30) <br />S OWNER <br />OWNER PHONE (15) 209-599-2188 <br />STATE (18) 19. A I ZIP (19) <br />CONTACT PHONE (21) 209-599-2188 <br />STATE (24) (_ , I ZIP (25) <br />NAME (3 1) IBUD DEN OUDEN <br />TITLE (32) IGENERAL MANAGER <br />BUSINESS PHONE (33) 209-599-2188 <br />24-HOUR PHONE (34) ,nndnn r<i <br />PAGER # (35) <br />ON-SITE EHS (36) yES 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) DUSTY VAN LAAR <br />NAME OF OWNER/OPERATOR (39) 1BUD DEN OUDEN <br />DATE (40) <br />DATE REC'D: 12/28/04 <br />