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UNI` D PROGRAM CONSOLIDATED FORM <br /> FACILITY INFORMATION <br /> BUSINESS OWNER/OPERATOR IDENTIFICATION <br /> Page 2 of 5 <br /> I. IDENTIFICATION <br /> FACILITY ID# 1 BEGINNING DATE 100 1 ENDING DATE 101 <br /> BUSINESS NAME(Same as FACILITY NAME or DBA—Doing Business As) 3BUSINESS PHONE 102 <br /> LensCrafters—Store Number 135 (209) 4774114 <br /> BUSINESS SITE ADDRESS 103 <br /> 4950 Pacific Avenue <br /> CITY 104 ZIP CODE 105 <br /> Stockton CA 95207 <br /> DUN&BRADSTREET 106 SIC CODE(4 digit#) law <br /> 779-1013642 5995 <br /> COUNTY 108 <br /> San Joaquin <br /> BUSINESS OPERATOR NAME 109 BUSINESS OPERATOR PHONE 110 <br /> LensCrafters, Inc. (513) 765-6000 <br /> H. BUSINESS OWNER <br /> OWNER NAME 111 OWNER PHONE 112 <br /> LensCrafters, Inc. (513) 765-6000 <br /> OWNER MAILING ADDRESS 113 <br /> 4000 Luxottica Place <br /> CITY 114 1 STATE 115 1 ZIP CODE 116 <br /> Mason OH 45040 <br /> III. ENVIRONMENTAL CONTACT <br /> CONTACT NAME 117 CONTACT PHONE 118 <br /> Rob Robison (513) 765-6274 <br /> CONTACT MAILING ADDRESS 119 <br /> 4000 Luxottica Place <br /> CITY 120 1 STATE 121 1 ZIP CODE 122 <br /> Mason OH 45040 <br /> -PRIMARY- IV. EMERGENCY CONTACTS -SECONDARY- <br /> NAME 123 NAME 128 <br /> Patrick Leahy Anita Martinez <br /> TITLE 124 TITLE 129 <br /> General Manager Region Quality Coordinator <br /> BUSINESS PHONE 125 BUSINESS PHONE 130 <br /> (209) 4774114 (661)832-6508 <br /> 24-HOUR PHONE 126 24-HOUR PHONE 131 <br /> (916) 9954894 (661)428-0176 <br /> PAGER# 127 PAGER# 132 <br /> N/A I N/A <br /> ADDITIONAL LOCALLY COLLECTED INFORMATION: 133 <br /> Certification: Based on my inquiry of those individuals responsible for obtaining the information,I certify under penalty of law that I have personally examined and <br /> am familiar with the information submitted and believe the information is true,accurate,and complete. <br /> A OF OW OPERATOR OR DESIGNATED REPRESENTATIVE DATE 134 1 NAME OF DOCUMENT PREPARER 135 <br /> Rob Robison <br /> NA'Mt OF SIGNER(priW 136 TITLE OF SIGNER 137 <br /> Peter Grimes Associate Vice President, Quality Manufacturing <br /> UPCF ( 1/99 revised) OES FORM 2730(1/99) <br />