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UPCF(Re,. 12,2007) <br />UNIFIED PROGRAM CONSOLIDATED FORM <br />FACILITY INFORMATION <br />BUSINESS OWNER/OPERATOR IDENTIFICATION <br />107/30/2009 - 03:17:46 PM <br />Page of <br />1. IDENTIFICATION <br />FACILITY IDd 3872 <br />1 1 <br />BEGINNING DATE NSA 100 <br />ENDING DATE N/A <br />101 <br />BUSINESS NAME (Same as FACILITY NAME <br />cr DBA - Doing Business As) 3 <br />BUSINESS PHONE <br />102 <br />PG&E STOCKTON SVC CTR <br />209-942.1400 <br />BUSINESS SITE ADDRESS <br />103 <br />BUSINESS FAX <br />1021 <br />4040 WEST LN <br />Not Collected <br />I <br />BUSINESS SITE CITY <br />ZIP CODE 105 <br />COUNTY <br />108 <br />STOCKTON <br />CA <br />95204 <br />I <br />SAN JOAQUIN <br />DUN & BRADSTREET <br />106 <br />PRIMARY SIC 107 <br />PRIMARY NAICS <br />107a <br />00-691-2877 <br />4931 <br />Not Collected <br />BUSINESS MAILING ADDRESS <br />1080 <br />BUSINESS MAILING CITY <br />108 <br />STATE 108c ZIP CODE <br />im <br />BUSINESS OPERATOR NAME <br />109 <br />BUSINESS OPERATOR PHONE <br />110 <br />PG&E <br />209-942-1620 <br />11. BUSINESS OWNER <br />OWNER NAME 114 t <br />III <br />OWNER PHONE t I5t <br />112 <br />PG&E <br />415-973-7000 <br />1 <br />OWNER MAILING ADDRESS <br />113 <br />C/O ENV SERVICES, 3401 CROW CANYON <br />ROAD <br />OWNER MAILING Cl TY <br />114 <br />STATE 115ZIPCODE <br />116 <br />SAN RAMON <br />CA <br />94583 <br />111. ENVIRONMENTAL CONTACT <br />CONTACT NAME <br />117 <br />CONTACT PHONE <br />jig <br />MICHELLE LE <br />1 209-942-1566 <br />CONTACT MAILING ADDRESS <br />119 <br />CONTACT EMAIL <br />1190 <br />9575 VICTOR <br />RD <br />RPRb�uPGEC09I <br />CONTACT MAII IN(; CI I <br />120 <br />STA"IF I'1 <br />ZIP CODE <br />112 <br />VICTOR <br />CA <br />95253 <br />IV. EMERGENCY CONTACTS <br />NAME <br />12.3 NAME <br />128 <br />DENNIS WHITE <br />MICHELLE LE <br />TITLE <br />124 TITLE <br />129 <br />DISTRIBUTION SPECIALIST <br />ENVIRONMENTAL SPECIALIST <br />BUSINESS PHONE 209-942-1620 <br />125 BUSINESS <br />PHONE 209-942-1566 <br />130 <br />24-HOUR PHONE 888-7434911 <br />126 24-HOUR <br />PHONE 800-874-4043 <br />131 <br />PAGER # NSA <br />127 PAGER <br />p NLA <br />132 <br />ADDITIONAL LOCALLICOLLECTED INFORMATIONS <br />133 <br />COMPLETE PAGE 2 OF BUSINESS OWNER/OPERATOR IDENTIFICATION <br />Cenifi"'wn Rased w nn mymnrof those mdividnals responsible frn obuining the Information. I crmfy nmler penahv of Ian be signing below or cenVly'rng b• the <br />esubllsh>d prwrsus nn the Admimsrcrung Asenov's <br />H]1MP Compliance %N ebsne that I hair perannnlh csamineJ and am familiar with the infnnnnimn submitKd and <br />believe the Infonnmion is uur. xrnmre. and eom km <br />SIGNATURE OF OWNE.RIOPERATOR OR DESIGNATED REPRESENTATIVE <br />DATE 134 NAME OF DOCIIMENT PREPARER <br />135 <br />NAME OF SIGNER (print <br />136 <br />rITLE OF SIGNER <br />137 <br />UPCF(Re,. 12,2007) <br />