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BUSINESS IDENTIFICATION FORM http://sjoesdata.org/of hmmp/section_tables/CF MIRF-Is_review.l... <br /> Main Menu <br /> BUSINESS OWNER/OPERATOR IDENTIFICATION DATA ENTRYJ ACCOUNT#:6929 <br /> I. IDENTIFICATION <br /> BUSINESS NAME(4) GOLDEN STATE IRRIGATION SVCS BUSINESS PHONE NUMBER(5) 209-943-7774 <br /> SITE ADDRESS (6) 1648 N SHAW RD <br /> STREET NO DIRECTION STREET NAME STREET TYPE APPT/BLDG/SUITE <br /> CITY(7) STOCKTON STATE(8) CA ZIP(9) 95215 <br /> DUN & <br /> BRADSTREET(10) 14-813-1493 SIC CODE(4 DIGIT#) (11) 0721 <br /> OPERATOR NAME(12) SCOTT SILVA OPERATOR PHONE(13) 209-943.7774 <br /> II. BUSINESS OWNER <br /> OWNER NAME(14) VALMONT INDUSTRIES OWNER PHONE(15) 800-825-6668 <br /> OWNER ADDRESS(16) <br /> CITY(17) STATE(18) ZIP(19) <br /> III. ENVIRONMENTAL CONTACT <br /> CONTACT NAME(20) SCOTT SILVA CONTACT PHONE(21) 209-943-7774 <br /> CONTACT ADDRESS(22) STREET NUMBER DIRECTION STREET NAME STREET TYPE APPT/BLDG/SUITE <br /> If different from <br /> #6 or#41 <br /> [TY(23) STATE(24) ZIP(25) <br /> IV. EMERGENCY CONTACTS <br /> PRIMARY SECONDARY <br /> NAME(26) SCOTT SILVA NAME(31) AGUSTIN VALDEZ <br /> TITLE CORPORATE GENERAL MANAGER TITLE(32) SHOP/FABRICATION FOREMAN <br /> BUSINESS PHONE(28) 209-943-7774 BUSINESS 209-943-7774 <br /> PHONE(33) <br /> 24 HOUR PHONE(29) 209-610-1417 24 HOUR PHONE(34) 209-603-0251 <br /> (AFTER BUSINESS HOURS) (AFTER BUSINESS HOURS) <br /> PAGER/CELL N/A PAGER/CELL N/A <br /> NUMBER(30) NUMBER(35) <br /> EXTREMELY HAZARDOUS SUBSTANCES (EHS) <br /> ON-SITE EH&S(36) NO If yes,and above Threshold Quantities,attach a sheet of paper with a general <br /> description of the process and principle equipment. <br /> ADDITIONAL LOCALLY COLLECTED INFORMATION (37) <br /> NAME OF DOCUMENT PREPARER(38) SCOTT SILVA <br /> NAME OF OWNER/OPERATOR 39 CORP DATE 40 <br /> BUSINESS MAILING AND BILLING INFORMATION <br /> MAILING ADDRESS(41) <br /> (If dRferont from S4 Address(6),owerw a leave blank.) <br /> NOTE:ALL TME SENSME AND OFFICIAL CORRESPONDENCE WILL BE SENT TO THS ADDRESS <br /> STREET NUMBER DIRECTION STREET NAME STREET TYPE STE/APPT/BLDG <br /> I oft 6/17/2010 8:51 AM <br />