HomeMy WebLinkAbout1030 OAK STREET (8)15-0?.1-001296, CIRCLE K STORE 2708G06, 17./5/2008 2:03:56 YM
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UNTFIFll PROCRAM CONSOLIDATED FaRM
FACILITY IM~ORMA'1'ION
BUSINESS OWNER/OPERATOR IDENTIFICATION
Poge of
L 1DLNTIFICATION
1'ACILI7'Y IDH ~ BEGINNINCi DA'PE J~ ENDING DATG ~o~
1 5 0 2 1 ;;\..:;;: 0 0 1 2 9 6 07/0112008 06/3012009
T3USINN.SSNAMG~SomeasFAC11.17YNAM0or06A- Uoin~BusinessA~) 3 RUSINESSPHON~ ~ ~~
CIRCLE K STORE 2708606 661-861-8048
NUSINESS SITG ADDRGSS ~~
1030 OAK ST
CITY ~~~ "LIY CODE ~~
BAKERSFIELD ~A 93304
DUN & BRADSTREET ~~ SIC CODE (4 digit a) ~~~
10-5457662 5541
COUNTY ioe
KERN
AUSINf:SS OPF.RA7'OR NAMC: ~~ k3USINGSS OPERATOR PI•IONE ~~~
MANAGER ON DUTY 661-861-8048
II. BUSINESS OWNER
OWNGRNAME ~~~ OWNERPHONE ~~Z
CIRCLE K STORES INC 951-270-5193
OWNRR MAILINa ADDRESS ns
495 E RINCON ST
CITY 114 STATC 115 7.IPCODE ~~~
CORONA CA 92879
III. ENVIRONMENTAL CUNTAC7'
CONTACTNAME ~~~ CONTACTPHONE ~~a
RICH GOSSETT 951-270-5193
CON'l'ACT MAILING ADDRESS ~ ~9
495 E RINCON ST
CITY tzo g•pq~~~ ~z~ ZIP CODE Iia
CORONA CA 92879
-PRIMARY- IV. EMERGENCY CONTACTS -SECONDARY-
NAME 1zb NAME i2s
SERVICE CONTACT CTR KEVIN QUINN
TITLE ~~~ TITLG ~29
24 HOURS 24 HOURS
BUSINESS PHON~ ~u BUSINESS PHONE 130
866-805-4357 559-647-6910
24-IIOUR PIIONG ~24 24-h10UR PHON~ ~~~
866-805-4357 559-647-6910
PAGi:R H 127 PAGER N. ~32
AUDITIONAL LOCALLY COI.I.F.CT6D 1NFORMATION: ~33
15~021-001286•SUBMITTED•05•D ECEM B ER•06
Certification: Finsed on my inquiry of those individuuls respunsible for obtaining the infonn:dion, 1 certify unJer penalty of law ~hal 1 have pcrsnnally exnmined and
om femilier with the informalion-submitted and believe the information is 1rue, eccurete, and complete.
SIONATURE OF OWNEWOPL•R 0 FSIGN TED REPRESEMATI VE DATE !74 NAME OF DOCUMENT PRGPARER Us
12/05/2008 Stantec Consulting Inc.
NAMEOFSIGNE (pnn U6 9'ITI.F.OFSIGNF.R U7
RICH GOSSETT ENVIR. COMPLIANCE COORDINATOR
UPCP ( 1/99 revised) OES FORM 2730 (1/99)