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BUSINESS IDENTIFICATION FORM Page 2 of 4 <br /> PRIMAR# SECONDARY <br /> NAME (26) G3dl,LK}Zd NAME (31) _ D <br /> TITLE (27) TITLE (32) MAR <br /> SAN JOAQUIN COUNTY <br /> BUSINESS PHONE (28) <br /> OFFICE BUSINESS PHONE (33) YSERWCE: <br /> �'�, i�cf=�1QF <br /> 24 HOUR PHONE (29) 24 HOUR PHONE (34) <br /> (AFTER BUSINESS HOURS) - -- — (AFTER BUSINESS HOURS) <br /> PAGER NUMBER (30) PAGER NUMBER (35) <br /> EXTREMELY HAZARDOUS SUBSTANCES (EHS) <br /> ON-SITE EHS (36) ! If yes, please contact our office. <br /> ADDITIONAL LOCALLY COLLECTED INFORMATION (37) <br /> NAME OF DOCUMENT PREPARER (38) fA5)LD4440 t � <br /> NAME OF OWNER/OPERATOR (39) r�t C.Cig3W ,tsC <br /> BUSINESS MAILING AND BILLING INFORMATION <br /> MAILING ADDRESS (41) <br /> (If different from Site Address(6), otherwise leave blank.) <br /> NOTE: ALL TIME SENSITIVE AND OFFICIAL CORRESPONDENCE WILL BE SENT TO THIS ADDRESS <br /> 1675 W CHARTER = WAY <br /> STREET NUMBER DIRECTION STREET NAME STREET TYPE <br /> STOCKTON CA—1 95206 <br /> CITY STATE J ZIP <br /> BILLING ADDRESS (42) <br /> (If different from Mailing Address(41), otherwise leave blank.) <br /> NOTE:INCLUDE"CARE OF"INFORMATION <br /> /6�s rJ� a tbG4tfi"Z c ` f <br /> STREET NUMBER DIRECTION STREET NAME STREET TYPE <br /> STs'lc�� [6A-- ' 4sz � <br /> CITY STATE ZIP <br /> http://www.sjoesdata.org/action.lasso?-Database=oes_login&-layout=html&-response=chmirf update.la... 3/12/2007 <br />