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BUSINESS OWNER/OPERATOR IDENTIFICATION
KERN COUNTY ENVIRONMENTAL HEALTH SIo:KVICIo:S IJIo:I'AKTMt.:NT
2700 M STREET, SUrTE 300
BAKERSFIELD, CA 93301
661 862-8700 Fax 661 862-8701
o NEW BUSfNFSS 0 OUT OF BUSINESS ~ REVISE/UPDATE (EFFECTIVE 02 / 14/ 06)
I. IDENTIFICATION
BEGINNING DATE
02/14/2006
Unified Program Consolidated Form (UPCF)
FACILITY INFORMATION
Page -1 of _
FACILITY 10#
101
BUSINESS NAME (Same as FACILITY NAME or DBA -Doing Business As)
Wa1greens #3282
BUSINESS SITE ADDRESS
3815 Niles Street
CITY
Bakersfield
DUN & BRADSTREET
93-103-6651
COUNTY
Kern Count
BUSfNESS OPERATOR NAME
Walgreens Corporation
102
\OJ
CA
ZIP CODE
93306
SIC CODE (4 digit #)
5912/7384
105
104
106
107
U G 1 7 2006
lOB
109
BUSfNESSOPERATORPHONE
847-914-3853
no
II. BUSINESS OWNER
OWNER NAME
Walgreens Corporation
OWNER MAILING ADDRESS
200 Wilmot Road
CITY
Deerfield
III
OWNER PHONE
847-914-3853
J 11
11.1
114 STATE
II..
ID. ENVIRONMENT AL CONTACT
CONTACT NAME en". C4Mfh'an.tt ll7
Christina Chiappetta, Safety & CSlBr1;<>"rp. FnviTl'""l0Bta1 Supervisor, MS 2171
CONTACT MAILING ADDRESS
200 Wilmot Road
CITY
Deerfield
115 ZIP CODE
60015
116
CONTACT PHONE
847-914-3195
118
119
-PRIMARY-
120 STATE
II..
IV. EMERGENCY CONTACTS
121 ZIP CODE
60015
-SECONDARY-
1::!2
NAME
Gena Mathis
TITLE
Store Manager
BUSINESS PHONE
661-363-0637
24-HOUR PHONE
661-565-3350
PAGER #
N/A
ADDITIONAL LOCALLY COLLECTED INFORMATION:
APN: 1 3
J23 NAME 128
Agnes Macapaga1
124 TITLE 129
District Photo Supervisor
125 BUSINESS PHONE 130
559-307-7100
126 24-HOUR PHONE 131
559-307-7100
127 PAGER # 132
N/A
133
5 _ 0 3 2 _ 2 0_0 0_0
Environmental Contact E-Mail Address:christina.chiappetta@wa1greens.com
Certification: Based on my mquiry of those individuals responsible for obtaining the information, I certify under penalty of law that I have personally examined and
am fami/iar with the information submitted and believe the information is true, accurate, and complete.
DATE7/31/tJv 134 NAME OF DOCUMENTPREPARER 135
02114/W06 Alison Millard, Agent for Walgreens Corporation
136 TITLE OF SIGNER \37
Divisional Merchandise Manager
SIGNATURE OF OWNER/OPERATOR OR
NAME OF SIGNER (print)
Dean Jarrett