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FROM DR ARCHER EXCAVATING • FRX NO. •Feb. 07 2006 12:11PM P3 <br /> BUSINESS OWNER/OPERATOR IDENTIFICATION FORM As�oum#:L= <br /> 5/3/2007 <br /> 1. 1DFNTIFICA'1rION <br /> BUSINESS NAME (4)ID.A. ARCHER EXCAVATING BUSINESS PHONE(5) 209-601-3745 <br /> SITE ADDRESS (6) 775 ❑SECOND IST <br /> Street 10. Di¢ctioa Stmt Name 5vect ryw A JL1Id Suite <br /> CITY (7) STOCKTON SIATh(R)CA ZIP(9) 95206 <br /> DUN& (10)158499132 SIC CODE(4 DIGIT#)01) N/A <br /> BRADSTREET <br /> OPERATOR (12) <br /> NAME A ARCHER JR OPERATOR PHONE(13)NAME 209-601.3745 <br /> 11.BUSINESS OWNER <br /> OWNER NAME_O4) DAVID A ARCHER JR OWNER PHONE(15) 209.601-3745 <br /> OWNER MAILING ADDRESS(16) 5948 E.WATERLOO ROAD <br /> (If different from site address) <br /> CITY(17) STOCK'fON STATE(I R) CA ZIP(19) 95215 <br /> 111. ENVIRONMENTAL CONTALT <br /> CONTACT NAME(20) AVID A ARCHER JR CONTAC:IPHONE(21) 209.601.3745 <br /> MAILING ADDRESS <br /> 0f different Prom site address)=❑ <br /> Street No. DirectionStreet:Name Street c A tBld /Suitt <br /> CITY(23) STATE(24) ❑ ZIP(25) <br /> Prianry IV. EMERGENCY CONTACTS Sevnftry <br /> NAME(26) DAVID ARCHER,JR. NAME(31) LAURIE ARCHER <br /> Dii.:(27) OWNER TITLE(32) OWNER <br /> BUSINESS PHONE(29) 209-931-6135 BUSINESS PHONE(33) 20y_931-6135 <br /> 24-HOUR PHONE(29) 209-601.3745 24-HOUR PHONE(34) 209-609-9457 <br /> PAGER#(30) N/A-- Ell PA06R#(15) N/A <br /> EXTREMELY HAZARDOUS SUBSTANCES (EHS) <br /> ON-SITE ENS (36) NO If yes,and above Threshold Planning Quantities,attach u shert of paper with a general <br /> description of the prmm and principle equipment involved with the ERS. <br /> ADDITIONAL LOCALLY COLLECTED INFORMATION(37) Provide information requested on the 2nd page of this form <br /> NAME OP DOCUMENT PREPARER(39) DAVID ARCHER JR <br /> NAME OF OWNER/OPERAT'OR(59) DAVID ARCHER .IR DA'TE(40) <br />