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• <br /> BUSINESS IDENTIFICATION FORM Page 2 of 4 <br /> PRIMARY SECONDARY <br /> NAME (26) 1 CLARK FREGIEN NAME (31) ;STEPHEN SEIBLY <br /> .......... ...................... ................. <br /> TITLE (27) 11VICE PRESIDENT OF OPERATIO1 TITLE (32) [SEC-TREAS <br /> ............................................... . <br /> ............................ <br /> ..............---..........................I..................... <br /> ............................................................ <br /> BUSINESS PHONE (28) 209-931-3738 BUSINESS PHONE (33) 1209-931-3738 <br /> ;209-351............................ .............12.... <br /> -50 <br /> 24 HOUR PHONE (29) 209-887-3965 24 HOUR PHONE (34) <br /> (AFTER BUSINESS HOURS) (AFTER BUSINESS HOURS) <br /> 2 <br /> PAGER NUMBER (30) 209-481-2797 PAGER NUMBER 209-351-5.-..........- 01 <br /> ,........ ---- <br /> .................. <br /> EXTREMELY HAZARDOUS SUBSTANCES (EHS) <br /> .......... --- <br /> ON-SITE EHS (36) NO If yes, please contact our office. <br /> ADDITIONAL LOCALLY COLLECTED INFORMATION (37) <br /> ......... ....... ... ....... ...... . ....... <br /> NAME OF DOCUMENT PREPARER (38) JANE MURPHY <br /> ........... .................................-............ ........................... .............................-.........................................-.......... <br /> NAME OF OWNER/OPERATOR (39) CLARK FREGIEN -STEPHEN SEIBLY <br /> BUSINESS MAILING AND BILLING INFORMATION <br /> MAILING ADDRESS (41) <br /> (If different from Site Address(6),otherwise leave blank.) <br /> NOTE: ALL TIME SENSITIVE AND OFFICIAL CORRESPONDENCE WILL BE SENT TO THIS ADDRESS <br /> .......... ............- .................: <br /> STREET NUMBER DIRECTION STREET NAME STREET TYPE <br /> ........... <br /> CITY STATE ZIP <br /> BILLING ADDRESS (42) <br /> (If different from Mailing Address(41),otherwise leave blank.) <br /> NOTE:INCLUDE"CARE OF"INFORMATION <br /> ...............- ................................ ........................... <br /> ........... ............... ....................._... <br /> 0 STREET NUMBER DIRECTION STREET NAME STREET TYPE <br /> ..............I............. .._......., <br /> CITY STATE ZIP <br />