Laserfiche WebLink
UNIFIED PROGRAM CONSOLIDATED FORM <br />FACILITY INFORMATION <br />BUSINESS OWNER/OPERATOR IDENTIFICATION <br />12/28/2009 - 04:21:46 PM <br />Page of <br />I. IDENTIFICATION <br />FACILITY ID# 4388 I 1 <br />BEGINNING DATE N/A 100 <br />ENDING DATE N/A 101 <br />BUSINESS NAME (Same as FACILITY NAME or DBA - Doing Business As) 3 <br />BUSINESS PHONE 102 <br />PG&E STOCKTON GAS PLANT <br />209-932-6550 <br />BUSINESS SITE ADDRESS 103 <br />BUSINESS FAX 102 <br />535 S CENTER ST <br />Not Collected <br />BUSINESS SITE CITY104 <br />ZIP CODE 105 <br />COUNTY 108 <br />STOCKTON <br />CA <br />95203 <br />SAN JOAQUIN <br />DUN & BRADSTREET 106 <br />PRIMARY SIC 107 <br />PRIMARY NAICS 107a <br />00-691-2877 <br />4931 <br />Not Collected <br />BUSINESS MAILING ADDRESS 108a <br />535 S CENTER STREET <br />BUSINESS MAILING CITY 108t <br />STATE I08c <br />ZIP CODE 108d <br />STOCKTON <br />CA <br />95203 <br />BUSINESS OPERATOR NAME 109 <br />B SINESS OPERATOR PHONE 110 <br />PG&E <br />209-932-6555 <br />H. BUSINESS OWNER <br />OWNER NAME (14) 111 <br />OWNER PHONE (15) 112 <br />PG&E <br />415-973-7000 <br />1 <br />OWNER MAILING ADDRESS 113 <br />C/O ENVIRONMENTAL SERVICES, 3401 CROW CANYON ROAD <br />OWNER MAILING CITY 114 <br />STATE 115 <br />ZIP CODE I I n <br />SAN RAMON <br />CA <br />94583 <br />Ill. ENVIRONMENTAL CONTACT <br />CONTACT NAME 117 <br />CONTACT PHONE 118 <br />MICHELLE LE <br />1 209-942-1566 <br />CONTACT MAILING ADDRESS 119 <br />CONTACT EMAIL 11911 <br />PO BOX K <br />M2L2@PGE.COM <br />CONTACT MAILING CITY 120 <br />STATE 121 <br />ZIP CODE 122 <br />VICTOR <br />CA <br />95253 <br />IV. EMERGENCY CONTACTS <br />NAME ROGER MORSHEAD- 123 NAME <br />MICHELLE LE -EMERGENCY 128 <br />EMERGENCY COORDINATOR <br />COORDINATOR <br />TITLE 124 TITLE <br />129 <br />DISTRIBUTION SUPERVISOR <br />ENVIRONMENTAL SPECIALIST <br />BUSINESS PHONE 209-932-6555 125 BUSINESS <br />PHONE 209-942-1566 130 <br />24-HOUR PHONE 888-743-4911 126 24-HOUR <br />PHONE 800-874-4043 131 <br />PAGER/CELL # N/A 127 PAGER/CELL <br /># 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 those individuals responsible for obtaining the information, I certify under penalty of law by signing below or certifying by the <br />established processes on the Administerting Agency's HMMP Compliance Website that I have personally examined and am familiar with the information submitted and <br />believe the information is true, accurate, and complete. <br />SIGNATURE OF OWNER/OPERATOR OR DESIGNATED REPRESENTATIVE <br />DATE 134 <br />1 NAME OF DOCUMENT PREPARER 13; <br />NAME OF SIGNER (print) 136 <br />TITLE OF SIGNER I3- <br />UPCF (Rev. 12/2007') <br />