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Stockton/FC -TNIFIED PROGRAM CONSOLIDATED FO--M <br /> FACILITY INFORMATION <br /> BUSINESS OWNER/OPERATOR IDENTIFICATION <br /> Page <br /> L IDENTIFICATION <br /> AGILITY ID# 1. BEGINNING DATE 100. ENDING DATE 101. <br /> (Agency use Only) - - 12/15/2008 12/31/2009 <br /> BUSINESS NAW(Same.FAcmrryNAME) 9 BUSINESS PHONE 102. <br /> Pa e Trucks (209) 323-2931 <br /> BUSINESS SITE ADDRESS 103, <br /> 10998 S. Harlan Road <br /> CITY 104. ZIP CODE 105. <br /> French a CA 5231 <br /> DUN&BRADSTREET 106. SIC CODE(4 digit#) 107. <br /> 88-456-4295 5012 <br /> COUNTY tog. <br /> San Joa uin <br /> BUSINESS OPERATOR NAME 109. BUSINESS OPERATOR PHONE 110. <br /> Par)6 Trucks Inc. 209 983-6970 eart. <br /> II. BUSINESS OWNER <br /> OWNER NAME 111. OWNER PHONE 112. <br /> PaP6 Trucks Inc. 541 341-3344 ext. <br /> OWNER MAILING ADDRESS 113. <br /> 355 Goodpasture Island Road <br /> CITY 114. STATE 115. ZIP CODE 116. <br /> Eugene I OR 197401 <br /> IIL ENVIRONMENTAL CONTACT <br /> CONTACT NAME 117• CONTACT PHONE 119. <br /> Mr. Bryan McCam bell 541 341-3344 ext. <br /> CONTACT MAR ING ADDRESS 119. <br /> 355 Goodpasture Island Road <br /> CITY 120. STATE 121. ZIP CODE 122. <br /> Eugene OR 97401 <br /> -PRIMARY- IV. EMERGENCY CONTACTS -SECONDARY- <br /> NAME 123. NAME 129. <br /> Mr. John Bernadicou Mr. Randy Da <br /> TITLE 124. TITLE 129. <br /> General Manager Product Support Manager <br /> BUSINESS PHONE 125. BUSINESS PHONE 130. <br /> 209 983-6970 ext. 209 983-6970 ext. <br /> 24-HOUR PHONE* 126. 24-HOUR PHONE* 131. <br /> 209 603-7303 ext. 209 815-2803 ext. <br /> PAGER# 127- PAGER# 132. <br /> ADDITIONAL LOCALLY COLLECTED INFORMATION: 133. <br /> Billing Address: 355 Goodpasture Island Road, Eugene, OR 97401 <br /> Property Owner: Steven Beneto Phone No.: (916) 371-7970 <br /> P.O. Box 1496, W. Sacramento, CA 95691 <br /> Nature of Business: Truck Sales/Parts/Service Type of Business: Corporation <br /> APN 193-330-30 Fire District: French Camp <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 /> SIG ATURE OF OPEnORDESIGNATEDREPRESENTAT17VE DAT�hl <br /> 134. NAME OF DOCUMENT PREPARER 135. <br /> / Janet Bailey Consultant <br /> I F IG 136. TME F SIG 137. <br /> Mr. <br /> -t) <br /> an McCam bell Environmental & Facilities Manager <br /> *See Instructions on next page. <br />