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. 4 <br /> UNIFIED PROGRAM CONSOLIDATED FORM <br /> FACILITY INFORMATION <br /> BUSINESS OWNER/OPERATOR IDENTIFICATION <br /> (4/23/2010- 12:31:17 PM) <br /> Page of <br /> I. IDENTIFICATION <br /> FACILITY ID# 5000 l 1 BEGINNING DATE NSA 100 ENDING DATE NSA 101 <br /> BUSINESS NAME(Same as FACILITY NAME or DBA-Doing Business As) 3 BUSINESS PHONE 102 <br /> PEP BOYS #711 209-952-1222 <br /> BUSINESS SITE ADDRESS 103 BUSINESS FAX 10 <br /> 4987 WEST LN Not Collected <br /> BUSINESS SITE CITY104 ZIP CODE 105 COUNTY 108 <br /> STOCKTON CA 95210 SAN JOAQUIN <br /> DUN&BRADSTREET 106 PRIMARY SIC 107 PRIMARY NAICS 107 <br /> 16-732-3419 7538 Not Collected <br /> BUSINESS MAILING ADDRESS 1 <br /> 3111 W ALLEGHENY AVE <br /> BUSINESS MAILING CITY 109t STATE 101k 2IP CODE 108d <br /> PHILADELPHIA PA 19132 <br /> BUSINESS PEdtA OR NAME 109 BUSMUSTOPERATOR PHONE 110 <br /> THE PEP BOYS 209-952-1222 <br /> H. BUSINESS OWNER <br /> OWNER NAME(14) 111 1 OWNER PHONE(15) 112 <br /> THE PEP BOYS-MANNY,MOE&JACK 215430-9017 <br /> OWNER MAILING ADDRESS 113 <br /> 3111 WEST ALLEGHENY AVE <br /> OWNER MAILING CITY 114 STATE III ZIP CODE 11 <br /> PHILADELPHIA PA 19132 <br /> M. ENVIRONMENTAL CONTACT <br /> CONTACT NAME 117 1 CONTACT PHONE 118 <br /> ANGELA BANKS 215430-9645 <br /> CONTACT MAILING ADDRESS 119 CONTACT EMAIL 11 <br /> 3111 W ALLEGHENY AVE angela—banksOpepboys com <br /> CONTACT MAILING CITY 120 STATE 121 ZIP CODE 122 <br /> PHILADELPHIA PA 19132 <br /> IV. EMERGENCY CONTACTS <br /> NAME CARLOS MOSQUEDA I23 ME JERRY CASH 128 <br /> TITLE STORE MANAGER 124 TITLE 129 <br /> SERVICE MANAGER <br /> BUSINESS PHONE 209-952-1222 125 BUSINESS PHONE 209-952-1222 130 <br /> 24-HOUR PHONE 209406-1804 126 24H PHONE 209456-2745 131 <br /> PAGER/CELL# NSA 127 PAGER/CELL# NSA 132 <br /> ADDITIONAL LOCALLY COLLECTED INFORMATION: 133 <br /> COMPLETE PAGE 2 OF BUSINESS OWNER/OPERATOR IDENTIFICATION <br /> Certification: Based on my inquiry of those individuals responsible for obtaining the information,I certify under penalty of law by signing below or certifying by the <br /> established processes on the Administerting Agency's HMMP Compliance Website that I have personally examined and am familiar with the infonnaiton submitted and <br /> believe the information is true,accurate,and cottt etc. <br /> SIGNATURE OF OWNER/OPERATOR OR DESIGNATED REPRESENTATIVE DATE 134 1 NAME OF DOCUMENT PREPARER. 135 <br /> NAME OF SIGNER(print) 136 I1TLE OF SIGNER 137 <br /> UPCF(Rev.12/2007) <br />