Laserfiche WebLink
ED PROGRAM CONSOLIDATED FORM <br /> FACILITY INFORMATION <br /> BUSINESS OWNER/OPERATOR IDENTIFICATION <br /> Modification Date:01/21/2010 <br /> Last Website Update: 01/21/2010 Page or <br /> 1. IDENTIFICATION <br /> FACILITY ID# 10631 1 1 BEGINNING DATE N/A 100 ENDING DATE N/A 101 <br /> BUSINESS NAME(Same as FACILITY NAME or DBA-Doing Business As) 3 BUSINESS PHONE 102 <br /> A-1 TRANSMISSIONS 209-466.0151 107, <br /> BUSINESS SITE ADDRESS 103 1 BUSINESS FAX <br /> 3132 N WILSON WAY Not Collected <br /> BUSINESS SITE CITY 104 ZIP CODE 105 COUNTY 108 <br /> STOCKTON CA 95205 SAN JOAQUIN <br /> DUN&BRADSTREET 106 PRIMARY SIC 107 PRIMARY NAICS 107 <br /> 10-291-0346 7539 Not Collected <br /> BUSINESS MAILING ADDRESS 108 <br /> BUSINESS MAILING CITY 108 STATE 10 ZIP CODE 108d <br /> BUSINESS OPERATOR NAME 109 BUSINESS OPERATOR PHONE 110 <br /> ERIC GOODMAN 209-477-1492 <br /> II. BUSINESS OWNER <br /> OWNER NAME(14) 111 1 OWNER PHONE(15) 112 <br /> ERIC GOODMAN 209477-1492 <br /> OWNER MAILING ADDRESS 113 <br /> 4576 WINDING RIVER CIR. <br /> OWNER MAILING CITY 114 STATE 115 ZIPCODE 116 <br /> STOCKTON CA 95207 <br /> III. ENVIRONMENTAL CONTACT <br /> CONTACT NAME 117 CONTACT PHONE 118 <br /> ERIC GOODMAN 209477-1492 <br /> CONTACT MAILING ADDRESS 119 CONTACT EMAIL 119 <br /> N/A N/A N/A ericgmanC&msn.com <br /> CONTACT MAILING CITY 120 STATE 121ZIP CODE 122 <br /> N/A N/A N/A <br /> IV. EMERGENCY CONTACTS <br /> NAME ERIC GOODMAN 123 NAME DAN JONES 128 <br /> TITLE 124 TITLE 129 <br /> OWNER EMPLOYEE <br /> BUSINESS PHONE 209.466-0151 125 BUSINESS PHONE 209.466-0151 130 <br /> 24-HOUR PHONE 209-477-1492 126 24-HOUR PHONE 209-824-0264 131 <br /> PAGERICELL# N/A 127 PAGER/CELL# N/A 132 <br /> ADDITIONAL LOCALLY COLLECTED INFORMATION: 133 <br /> COMPLETE PAGE 2 OF BUSINESS OWNER/OPERATOR IDENTIFICATION <br /> Certification: Based on my inquiry of Nose individuals responsible for obtaining the information,l certify under penalty of law by signing below or certifying by the <br /> established processes on the Administering Agency's HMMP Compliance Website that I have personally examined and am familiar with the intormaiton submitted and <br /> believe Ne information is true,accurate,and complete. <br /> SIGNATURE OF OWNER/OPERATOR OR DESIGNATED REPRESENTATIVE DATE 134 NAME lF DOCUMENT PREPARER 135 <br /> NAME OF SIGNER(print) 136 TITLEOFSIGNER 137 <br /> UPCF Rev.12/2007 <br />