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IFIED PROGRAM CONSOLIDATED FORM <br /> FACILITY INFORMATION <br /> BUSINESS OWNER/OPERATOR IDENTIFICATION <br /> Page 1 of I <br /> I.IDENTIFICATION <br /> FACILITY ID# 1 FA0017702 BEGINNING DATE iap ENDING DATE 101 <br /> BUSINESS NAME(Same u FACILITY NAME a DBA-Dung Rwl N) 3 BUSINESS PHONE 102 <br /> TUNE UP&ALIGNMENT SPECIALISTS 209 941-0916 <br /> BUSINESS SITE ADDRESS 103 <br /> 3909 N WEST LN STE B <br /> CITY ZIP CODE 103 <br /> STOCKTON CA 95204 <br /> DUN&BRADSTREET 106 SIC CODE(4 digit#) 107 <br /> 184743805 7538 <br /> COUNTY <br /> IOa <br /> SAN JOA UIN COUNTY <br /> BUSINESS OPERATOR NAME I09 BUSINESS OPERATOR PHONE 110 <br /> TAING, STEVEN S <br /> 11.BUSINESS OWNER <br /> OWNER NAME III OWNER PHONE 112 <br /> TAING STEVEN SUYTRY <br /> OWNER MAILING ADDRESS <br /> 113 <br /> 3909 N WEST LN B <br /> CITY 114 STATE Ds ZIPCODE 116 <br /> STOCKTON I CA 95204 <br /> III.ENVIRONMENTAL CONTACT <br /> CONTACT NAME 113 CONTACT PHONE 118 <br /> STEVEN S TAING (209)941-0916 <br /> CONTACT MAILING ADDRESS 119 <br /> CITY 120 STATE 121 ZIP CODE 122 <br /> -PRIMARY- W.EMERGENCY CONTACTS -SECONDARY- <br /> NAME 123 NAME 128 <br /> STEVEN S TAING SEREY TAN <br /> TITLE 124 TITLE 129 <br /> OWNER SPOUSE <br /> BUSINESS PHONE 126 BUSINESS PHONE 130 <br /> 209 941-0916 209 946-3065 <br /> 24-HOURPHONE 126 24-HOUR PHONE 131 <br /> 209 951-7818 209 951-7818 <br /> PAGER# ❑p PAGER# 132 <br /> ADDITIONAL LOCALLY COLLECTED INFORMATION: 133 <br /> Certification: Based on my inquiry of those individuals responsible for obtaining the information,I certify under penalty of law that I have personally examined and am familiar with <br /> the information submitted and believe the information is true,accurate,and complete. <br /> SIGNATURE OF OWNER/OPERATOR OR DESIGNATED REPRESENTATIVE DATE 134 1 NAME OF DOCUMENT PREPARAR 133 <br /> NAME OF SIGNER(pw) 136 TITLE OF SIGNER 137 <br /> UPCF( 1/99 revised) <br />