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ak <br /> NIFIED PROGRAM CONSOLIDATED F <br /> FACIIJTV INFORMATION <br /> BUSINESS OWNER/OPERATOR IDENTIFICATION <br /> Last Website Update: ® Page_ of <br /> 1. IDENTIFICATION <br /> FACILITY TDs 13269 1 RFr,TNNTNr,DATE N/A 100 ENDING DATE N/A 101 <br /> BUSINESS NAME(Same as FACILITY NAME or DBA-Doine Business As) 3 BUSINESS PHONE 102 <br /> D.A.ARCHER EXCAVATING 209-601-3745 <br /> RGSNFSS STTF.ADDRESS 103 BUSINESS FAX <br /> 775 SECOND ST Not Collected <br /> BUSINESS SITE CITY 104 STP CODF 105 COUNTY 108 <br /> STOCKTON CA 95206 SAN JOAQUIN <br /> DUN&BRADSTREET 106 PRIMARY SIC 107 PRIMARY NAICS I o7 <br /> 158499132 N/A Not Collected <br /> RT TSTNF.SS MATT.TNO ADGRFSS lOR <br /> 5948 E WATERLOO RD <br /> BUSINESS MAILING CITY 108t STATE l OR ZIP CODE 108d <br /> STOCKTON CA 95215 <br /> BUSINESS OPERATOR NAME 109 BUSINESS OPERATOR PHONE 110 <br /> DAVID A ARCHER JR 209-601-3745 <br /> II. BUSINESS OWNER <br /> OWNER NAME(14) 111 1 OWNFRPRONF(15) - 112 <br /> DAVID A ARCHER JR 209-601-3745 <br /> OWNFR MAR.N(; ADDRESS 113 <br /> 5948 E.WATERLOO ROAD <br /> OWNFR MATTING CTTV 114 STATE 115 ZTP CODF 116 <br /> STOCKTON CA 95215 <br /> III. ENVIRONMENTAL CONTACT <br /> CONTACT NAME 117 I CONTACT PHONE 118 <br /> DAVID A ARCHER JR 209-601-3745 <br /> CONTACT MAILING ADDRESS 110 CONTACT EMAIL 119a <br /> daarcherex@yahoo.com <br /> CONTACT MAILING CITY 120 STATE 121 ZTP CODF. 122 <br /> IV. EMERGENCY CONTACTS <br /> Nth DAVID ARCHER,JR. 123 NAME LAURIE ARCHER 128 <br /> TITLE OWNER 124 TITLE OWNER 129 <br /> BUSINESS PHONE 209-931-6135 125 BUSINESS PHONE 209-931-6135 130 <br /> 24-HOUR PHONE 209-601-3745 126 94-HOI IR PHONF 209-609-9457 131 <br /> PACWR/C.RT.T.4 N/A 127 PAGFR/rFTt.ri 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 OWNER/OPERATOR OR DESIGNATED REPRESENTATIVE DATE 134 1 NAME OF DOCUMENT PREPARER 135 <br />