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BUSINESS OWNER/OPERA T IDENTIFICATION PAGE SIDE 1 <br /> BEGINNING DATE(I) 1/1/2002 I, IDENTIFICATIO\' (3)PAGE 1 OF <br /> BUSINESS NAME (4) Marigold Shell BUSINESS PHONE:(5) [209-952-4862 <br /> SITE ADDRESS (6) 6131 Pacific Avenue <br /> —A-'% —; <br /> A-'%'� "'"�;�*�D Street No. Direction Street Name Street Type Apt/Bldg/Suite <br /> ,_- —_ <br /> CITY 0 C T 0 3 2002 (7) Stockton STATE(8) CA ZIP(9) 95207 <br /> DUN& 140119IM COUNW10) 00-429-4737 SIC CODE(4 DIGIT#) (1 t) 5411 <br /> BR-ADSTREET �,CYSERVICE <br /> OPERATOR (12) Hung Tran OPERATOR PHONE (13) 209-952-4862 <br /> NAME <br /> II. BUSINESS OWNER <br /> OWNER NAME (14) Hung Tran OWNER PHONE(15) F209-952-4862 <br /> OWNER MAILING ADDRESS (16) 6131 Pacific Avenue <br /> (if different from site address) <br /> CITY (17) Fstolon STATE(18) CA ZIP(( 95207 <br /> III. ENVIRONMENTAL CONTACT <br /> CONTACT NAME (20) Bruce Marubashi CONTACT PHONE(21) F209-577-5960 <br /> MAILING ADDRESS (22) 3468 Claremont Ave <br /> (if different from site address) <br /> Street No. Direction Street Name Sn"eet Type A tBld Suite <br /> CITY (23) rNfodesto STATE (24) CA ZIP(2 95350 <br /> -Primary IV. EMERGENCY CONTACTS Secondary <br /> NAME: (26) Hung Tran NAME:(31) John Huynh <br /> TITLE:(27) Dealer TITLE:(32) Co-Dealer <br /> BUSINESS PHONE:(28) 209-952-4862 BUSINESS PHONE:(33) 209-952-4862 <br /> 24-HOUR PHONE: (29) 209-473-8205 24-HOUR PHONE: (34) 707-558-9324 <br /> PAGER#: (30) PAGER#: (35) <br /> EXTREMELY HAZARDOUS SUBSTANCES (EHS) <br /> ON SITE EHS (36)[]Yes Fx_1No If yes,and above Threshold Planning Quantities,attach a sheet of paper with a general <br /> description of the process and principal equipment. <br /> iDDITIONAL LOCALLY COLLECTED INFORMATION(37) Provide information requested on the back of this form <br /> Name of Document Preparer(38) RHL DESIGN GROUP INC. <br /> Name of Owner/Operator(39) j ` � Date(40) <br /> SJC 12/99 <br />