HomeMy WebLinkAboutHMBP UPDATE REQUEST 9/8/20081 ~V.~l~ -~Vl .~l R~ S ~O R~S, ~NC
Corporate Office - EnvironmentaCCompCiance
508 S~V 8`ti Street
Bentonville, AR 721716 -0505
M EM O R.~l ND'U ~bl
TO: E.NVIRONMEN'1".~IL .~IGENCy
,~'RO~bt: Shanedra Barnes
S'UBJEC7 'UPD.~L7ED 3-CMBP
D.~l?E: g/8/zoo8
PCease find encCosed an updated 3-CMBP for store ~~~ . If you have
any auestions me caCCme at 4~g-ZO4-6o48.
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Sfi.anedra Barnes Coor~na.tor, EnvironmentaCComyG.ance
Phone 479.zo4.6o48 ,~ax 479.2o4.og7i
s(~ianedra.6arnesCahvaC-ma.rt. com
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UNIFIED PROGRAM CONSOLIDATED FORM
FACILTTY INFORMATION
BUSINESS OWNER/OPERATOR IDENTIFICATION
I. IDENTIFICATION
FACIL[TY ID# ~g~'' r= ~ BEGINNING DATE ~oo ENDING DATE ~o~
~~ 5 '' `: D Z ~ ~~°
' D ~ /
F
~ 04/5/2008 04/4/2009
BUSINESSNAME(SameasFACILITYNAMEorDBA-DoingBusinessAs) 3 BUSINESSPHONE 10z
Wal-Mart Store #1574 (661) 398-7297
BUSINESS SITE ADDRESS ~03
2300 White Lane
C[TY ~~ ZIP CODE ios
Bakersfield C`~' 93304
DUN & BRADSTREET ~~ SIC CODE (4 digit #) ~o~
OS-195-7769 5311
COUNTY ios
Kern
BUSINESS OPERATOR NAME: 109 BUSINESS OPERATOR PHONE ~~o
Wal-Mart Stores, Inc. (479) 204-2324
II. BUSINESS OWNER
OWNER NAME: CONTACT: ~~~ OWNER PHONE ~~Z
Wal-Mart Stores, Inc., Attn: Licensing (479) 204-2324
OWNER MAILING ADDRESS 113
702 S.W. 8"' Street
CITY 114 STATE 115 ZIPCODE 116
Bentonville AR 72716-0500
III. ENVIRONMENTAL CONTACT
CONTACTNAME ~~~ CONTACTPHONE ~~g
OJ. Ward, Environmental Compliance Manager (479) 204-8579
CONTACT MA[LING ADDRESS ~ 19
Wal-Mart Corporate Compliance, 702 SW 8'~' Street
CITY ~ZO STATE 12~ ZIP CODE u2
Bentonville AR 72716-0500
-PRIMARY- IV. EMERGENCY CONTACTS -SECONDARY-
NAME 123 NAME ~28
Harry Fenske Cynthia Holland
TITLE 124 TITLE iz9
Store Manager Co-Manager
BUSINESS PHONE ~ZS BUSINESS PHONE 130
(661)398-7297 (661)398-7297
24-HOUR PHONE 126 24-HOUR PHONE 13~
(479) 204-3911 (479) 204-3911
PAGER # 127 PAGER # ~32
NA NA
ADDITIONAL LOCALLY COLLECTED INFORMATION: i33
APN:405-010-56-00-7
Environmental Contact E-Mail Address: Jamie.huens@wal-mart.com
Certification: Based on my inquiry of those individuals responsible for obtaining the information, 1 certify under penalty of law that 1 have personally examined and
am familiar with the infortnation submitted and believe the information is true, accurate, and complete.
U E F O ER/ PERATOR OR DESIGNATED REPRESENTATIVE DATE 4 NAME OF DOCUMENT PREPARER ~35
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Shaw Environmental Inc.
136
GN (print)
E OF SIGNER 13~
OJ. Ward Corporate Environmental Compliance Manager
Revised: 04/OS/2008 3 of 42