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BUSINESS IDENTIFICATION FORM <br />Page 1 of 3 <br />EMAIL BUSINESS ID RECORD <br />Instructions <br />BUSINESS OWNER/OPERATOR IDENTIFICATION DATA <br />ENTRY <br />ACCOUNT#: 9506 <br />I. IDENTIFICATION <br />BUSINESS NAME{4� <br />FORWARD INC LANDFILL <br />BUSINESS PHONE <br />209-982-4298 <br />NUMBER (5) <br />SITE ADDRESS (6) <br />9999 S AUSTIN RD <br />STREET NO DIRECTION STREET NAME STREET TYPE APPT/BLDG/SUITE <br />CITY {7I <br />MANTECA STATE (8) CA <br />ZIP 9 95336 <br />DUN & <br />BRADSTREET (10) <br />05-618-3791 SIC CODE (4 DIGIT #)(11) <br />7538 <br />OPERATOR NAME (12) <br />1RUBEN RAMIREZ� OPERATOR PHONE) (13) <br />'� <br />209-982-4298 <br />II. BUSINESS OWNER <br />OWNER NAME (14) <br />ALLIED WASTE IND OWNER PHONE (15) <br />480-627-2700 <br />OWNER ADDRESS (16)118500 <br />NORTH ALLIED WAY <br />CITY 17 PHOENIX STATE (18) I'" <br />ZIP 1 85054 <br />III. ENVIRONMENTAL CONTACT <br />CONTACT NAM(; (20) <br />JRUBEN RAMIREZ CONTACT PHONE <br />1209-982-4298 <br />m <br />COTACT (2 <br />2)ET <br />If different from #6 or <br />#41 STREDRESS <br />NUMBER DIRON STREET NAME <br />STREET E APPT/BLI DGJSUITE <br />I�(23) <br />STATE 24) F <br />ZIP 25 <br />IV. EMERGENCY CONTACTS <br />PRIMARY <br />SECONDARY <br />NAME (26) RUBEN RAMIREZ <br />NAME 31) KEVIN BASSO <br />TITLE (b OPS SUPERVISOR <br />TITLE (32) GENERAL MANAGER <br />BUSINESS PHONE (28) <br />209-982-4298 <br />BUSINESS PHONE (33) <br />1209-982-4298 <br />24 HOUR PHONE (291209-969-9952 <br />r <br />24 HOUR PHONE (34I <br />209 481-1763 <br />(AFTER BUSINESS HOURS) <br />(AFTER BUSINESS HOURS) <br />-"-' <br />http://sjoesdata.orgloes hmmplaetion.lasso?-Database=oes login&-layout=html&-respons... 7/14/2011 <br />