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BUSINESS IDENTIFICATION FO <br />JV <br />NAME (26) CLARK FREGIEN <br />TITLE PRESIDENT <br />.......... <br />BUSINESS PHONE (2 8) 209-931-3738 <br />24 HOUR PHONE (29) X209-887-3965 <br />(AFTER BUSINESS HOURS) <br />PAGER NUMBER (30) 209-481-2797 <br />Is <br />NAME (31) EUGENE GEORGE <br />TITLE 32 SEC-TREAS <br />BUSINESS PHONE (33) 209-931-3738 <br />24 HOUR PHONE (34) 4209-368-8600 <br />(AFTER BUSINESS HOURS) <br />PAGER NUMBER (35) 209-482-3119 <br />EXTREMELY HAZARDOUS SUBSTANCES (EHS) <br />ON-SITE EHS 36 _ NO If yes, please contact our office. <br />ADDITIONAL LOCALLY COLLECTED INFORMATION (37) <br />NAME OF DOCUMENT PREPARER (38) JANE MURPHY <br />NAME OF OWNER/OPERATOR (39) CLARK FREGIEN - EUGENE GEORGE <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 />STREET NUMBER DIRECTION STREET NAME <br />CITY STATE <br />BILLING ADDRESS (42) <br />(If different from Mailing Address (41), otherwise leave blank.) <br />NOTE:INCLUDE "CARE OF" INFORMATION <br />STREET NUMBER <br />CITY <br />DIRECTION STREET NAME <br />STATE <br />STREET TYPE <br />F..__. <br />ZIP <br />STREET TYPE <br />ZIP <br />Page 2 of <br />1,tfn-//ginesdata..org/action.lasso?-Database=oes to Rin&-lavout=html&-rest)onse=chmirf update. lasso &us... 1/18/200 <br />