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BUSINESS IDENTIFICATION FORM <br />wA <br />PAGER/CELL NUMBER (35) N/A <br />EXTREMELY HAZARDOUS SUBSTANCES (EHS) <br />ON-SITE EMS (361Np If yes, please contact our office. <br />ADDITIONAL LOCALLY COLLECTED INFORMATION (37) <br />NAME OF DOCUMENT PREPARER (38) 1RUBEN RAMIREZ <br />NAME OF OWNER/OPERATOR (39) IRUBEN RAMIREZ <br />BUSINESS MAILING AND BILLING INFORMATION <br />MAILING ADDRESS (411 <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 />1 I 1 <br />STREET NUMBER DIRECTION STREET NAME <br />CITY STATE <br />BILLING ADDRESS (42) <br />(If different from Mailing Address (41), otherwise leave blank.) <br />NOTEANCLUDE'CARE OF' INFORMATION <br />1 -- ............. I___71 <br />STREET NUMBER DIRECTION <br />CITY <br />1 <br />STREET NAME <br />STATE <br />I , <br />STREET TYPE <br />ZIP <br />STREET TYPE <br />ZIP <br />ADDITIONAL BUSINESS INFORMATION <br />Page 2 of 3 <br />STE/APPT/BLDG <br />STE/APPT/BLDG <br />TYPE OF { Single Owner t: Corporation r Partnership (" Public Agency <br />ORGANIZATION (43) <br />UNSTAFFED SITE Np <br />NETWORK (441 <br />ASSESSOR PARCEL NO. (451. 2010130-03 <br />PROPERTY OWNER JALLIED WASTE IND. PHONE NO. (47) j480-627-2700 <br />NAME (46 <br />PROPERTY OWNER 118500 NORTH ALLIED WAY <br />ADDRESS (4W _ <br />STREET ADDRESS <br />http://sjoesdata.org/oes_hmmplaction.lasso?-Database=oes login&-layout=html&-respons... 7/14/2011 <br />