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IED PROGRAM CONSOLIDATED FO <br /> FACILITY INFORMATION <br /> BUSINESS OWNER/OPERATOR IDENTIFICATION <br /> Page. of <br /> I. IDENTIFICATION <br /> FACILITY ID# <br /> BEGINNING DATE °= ENDING DATE <br /> 3 BUSINESS PHONE 102 <br /> BUSINESS NAME(sameas FACILITY NAME or DBA—Doing Business As) <br /> Valero Corner Store#3698 209-832-8815 <br /> 103 <br /> BUSINESS SITE ADDRESS <br /> 1h <br /> CIT E. 11 oa ZIP CODE 05 <br /> CITY CA <br /> Tracy 95376 <br /> DUN&BRADSTREET 106 SIC CODE(4 U1911#) <br /> 107 <br /> 00-917-4921 5541 06 <br /> COUNTY <br /> San Joaquin 109 BUSINESS OPERATOR PHONE ° <br /> BUSINESS OPERATOR NAME <br /> Valero California Retail Company 559-582-0241 <br /> lookag t If. BUSINESS OWNER i <br /> OWNER NAME 111 OWNER PHONE 112 <br /> Valero California Retail Company 559-582-0241 <br /> 113 <br /> OWNER MAILING ADDRESS <br /> 685 W. third Street „6 ZIP CODE 116 <br /> OIC, 11a STATE <br /> Hanford CA 93230-5000 <br /> Ill. ENVIRONMENTAL CONTACT <br /> 117 CONTACT PHONE 118 <br /> CONTACT NAME <br /> Sandy Huff _ 559-583-3298 e <br /> CONTACT MAILING ADDRESS <br /> 685 W. 3rd Street _ 122 <br /> CITY 120 STATE 121 ZIP CODE <br /> Hanford CA 93230-5000 <br /> -PRIMARY- IV. EMERGENCY CONTACTS -SECONDARY- <br /> NAME <br /> 123 NAME - 128 <br /> Maricela Richardson Dawn Pernsteiner <br /> TITLE 124 TITLE 1zs <br /> Station Manager Area Manager 130 <br /> BUSINESS PHONE 125 BUSINESS PHONE <br /> 24-HOUR <br /> -8815 PHONE 209-669-0341 <br /> 2HOUR <br /> 24- 126 24-HOUR PHONE 131 <br /> 209-667-9591 209-669-3402 <br /> PAGER# <br /> 127 PAGER# 132 <br /> ADDITIONAL LOCALLY COLLECTED INFORMATION: <br /> Certification: Based on my inquiry of those individuals responsible far obtaining the information,I certify under penalty of law that I have personally <br /> examined and am familiar with the information submitted and believe the information Is true,accurate,and complete. <br /> SIGNATURE OF OWNER/OPE R OR D SIG TED REPRESENTATIVE DATE 139 NAME OF DOCUMENT PREPARER 135 <br /> 0� Sand Huff <br /> NAMEOF SIGNER(print) 136 TITLE FSIGNER <br /> 137 <br /> Sandy Huff Operations & Envrionmental Specialist <br /> UPCF (1199 revised) HMP 2 DES FORM 2730(1199) <br />