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BUSINESS QWNER/OPERATC3 IDENTIFICATION FORM -_ Account#: 13268 <br /> 1. IDENTIFICATION <br /> BUSINESS NAME (4) WAYNE MOTOR COMPANY BUSINESS PHONE(5) 209-464-5299 <br /> SITE ADDRESS (6) 775 ❑ SECOND ST <br /> Street No. Direction Street Name Street Type Apt/Bldg/Suite <br /> CITY (7) STOCKTON STATE(8)I ZIP(9) <br /> CA 95206 <br /> DUN & (10) TBD SIC CODE(4 DIGIT#) (11) TBD <br /> BRADSTREET <br /> OPERATOR (12) WILLARD A WAYNE OPERATOR PHONE(13) 209-464-5299 <br /> NAME <br /> 11.BUSINESS OWNER <br /> OWNER NAME(14) WILLARD A WAYNE OWNER PHONE(15) 209-464-5299 <br /> OWNER MAILING ADDRESS(16) 1042 BEAR CREEK WAY <br /> (If different from site address) <br /> CITY(17) STOCKTON STATE(18) CA ZIP(19) 95209 <br /> III. ENVIRONMENTAL CONTACT <br /> CONTACT NAME(20) WILLARD A WAYNE CONTACT PHONE(21) 209-464-5299 <br /> MAILING ADDRESS(22) <br /> (If different from business 1675W❑ CHARTER WAY <br /> mailing address) <br /> Street No. Direction Street Name Street Type A t/Bld Suite <br /> CITY(23) FOCKTON STATE(24) E <br /> ZIP(25)195206 <br /> Primary IV. EMERGENCY CONTACTS Secondary <br /> NAME(26) WILLARD WAYNE NAME(3 1) HAROLD FLEGAL <br /> TITLE(27) TITLE(32) <br /> OWNER MECHANIC <br /> BUSINESS PHONE(28) 209-464-5299 BUSINESS PHONE(33) 209-464-5299 <br /> 24-HOUR PHONE(29) 209-473-7411 24-HOUR PHONE(34) 209-948-4018 <br /> PAGER#(30) 209-607-3333 PAGER#(35) N/A <br /> EXTREMELY HAZARDOUS SUBSTANCES (EHS) <br /> ON-SITE EHS (36) NQ 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) WILLARD WAYNE <br /> NAME OF OWNER/OPERATOR(39) WILLARD WAYNE DATE(40) <br /> DATE REC'D: 5/11/07 <br />