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IIUSINIsSS OWNER/OPERA'I'OR IDENTIFICATION PAGE SIDE l <br /> CAITNDAR YEAR BEGINNING(1) 1yy7 ENDING(2)1 (3) PAGE IOFE <br /> BUSINESS NAME (4) LIBERTY FIRE DISTRICT BUSINESS PHONE (5) <br /> ( 209) 339-1329 <br /> SI I1, ADDRESS (6) L 4124 LIN BRUELLA ROAD — <br /> Strcct No. Direction Strcct Name Street T Pe u le <br /> CITY (7) STATE(8) 'LIP(9) <br /> ACAMPO CA 95220 <br /> DUN & (I O> SIC CODE'(4 DIGIT#)(1 1) <br /> BRADSTRL•ET GO-580 58 86 9224 <br /> OI'E:RA'I'OR (12) OPERATOR PHONE(13) <br /> Nnn[E [ SrAN SEIFEKT <br /> OWNER INFORMATION <br /> OWN ERNAM E(14) LIBERTY FIRE DISTRICT OWNERPHONE(15) <br /> OWNER MAILING ADDRESS (16) <br /> (ll diffemil from site address) <br /> CITY (17) 1 STATE(18) El "Zll'(19) <br /> 1:NVIIZONMENTAI. CONTACT <br /> CONTACTNAME(20) CONTACT PI[ONE(2 I) <br /> [KAR7LN KAMMEREK (209 ) 339-1329 <br /> MAILING ADDRESS (22) <br /> (If different from rile address) <br /> Strcct No. Direction Street Nance StrectType A,UI31d /Suite <br /> CITY (2 3) STA'L'E(24) ZIP(25) <br /> Primary EMERGENCY CONTACTS Secoll(huy <br /> NAME(26) NAME(3 1) <br /> STAN SEIFERT TED LEVENTINI JR <br /> 'I'I'I'LIE(27) TITLE(32) <br /> CHIEF ASST. CHIEF <br /> BUSINESS PHONE(28) ( 209 ) 339-1329 BUSINESS PIIONS(33) 1( 209) 339-1329 <br /> 24-HOUR PHONE(29) ( 209 ) 367-0850 24-HOUR PHONE(34) <br /> ( 209 ) 334-0455 <br /> PAGER # (30) PAGER#(35) <br /> (209 ) 333-4171 ( 209) 333-4211 <br /> ACUTELY IIAZARDOUS MATERIALS (AHNI) <br /> ON-SPIT AI-IM (36) [:]YES ❑X NO If yes,and above 71treshold Planning Quantities,attach a sheet of Paper with a general <br /> description of the process and principle equipment. <br /> AD1)I'11ONAI. LUCAI.I.1' ('UI.I.Is('I1'.I) INFORMATION(31) Provide inlommlion requested on the hark of (his Bunt <br /> NAME OF DOCUMI?NT PREPARER (38) KAREN KAMMERER <br /> NAME- OF OWNER/OPERATOR (39) DAT( (4l)) <br /> STAN SEIFERT 1 /13/97 <br /> S1C 12/96 <br />