Laserfiche WebLink
BUSINESS OWNER/OPERATO IDENTIFICATION FORM Account#: 13269 <br /> I. IDENTIFICATION <br /> BUSINESS NAME (4) D.A. ARCHER EXCAVATING BUSINESS PHONE(5) 209-601-3745 <br /> SITE ADDRESS (6) 775 ❑ SECOND ST <br /> Street No. Direction Street Name Street Type A tBld Suite <br /> CITY (7) STOCKTON STATE(8)1 ICA ZIP(9) 95206 <br /> DUN& (10) 158499132 SIC CODE(4 DIGIT#) (11) N/A <br /> BRADSTREET <br /> OPERATOR (12) DAVID A ARCHER JR OPERATOR PHONE(13) 209-601-3745 <br /> NAME <br /> II. BUSINESS OWNER <br /> OWNER NAME(14) 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) STOCKTON STATE(18) CA ZIP(19) 95215 <br /> III. ENVIRONMENTAL CONTACT <br /> CONTACT NAME(20) DAVID A ARCHER JR CONTACT PHONE(21) 209-601-3745 <br /> MAILING ADDRESS(22) ❑ <br /> (If different from business <br /> mailing address) <br /> Street No. Direction Street Name Street Type Apt/Bid Suite <br /> CITY(23) F I STATE(24) El ZIP(25) <br /> Primary IV. EMERGENCY CONTACTS Secondary <br /> NAME(26) DAVID ARCHER, JR. NAME(3 1) LAURIE ARCHER <br /> TITLE(27) OWNER TITLE(32) OWNER <br /> BUSINESS PHONE(28) 209-931-6135 BUSINESS PHONE(33) 209-931-6135 <br /> 24-HOUR PHONE(29) 209-601-3745 24-HOUR PHONE(34) 209-609-9457 <br /> PAGER#(30) N/A PAGER#(35) N/A <br /> EXTREMELY HAZARDOUS SUBSTANCES (EHS) <br /> ON-SITE EHS (36) NO 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) DAVID ARCHER JR <br /> NAME OF OWNER/OPERATOR(39) DAVID ARCHER JR DATE(40) <br /> DATE REC'D: 5/3/07 <br />