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HomeMy WebLinkAboutHAZ-ONLINE INVENTORY 10/3/2008lir3idocs - Uniform Documents Zj ~ (v ? ~-- ~oo~ (7 / ~? f ~~Z~t"~~~:~ :~±~"~~~'~t.~~~ ~~~M~1~ ~~~t~~"i~~rlL'~/ ~~~Q~~~ Page 1 of 2 Viewing/Updating Facility Information After modifying the facil ity information below, click 'Update Facility' ta update the database. No Users Have Access to this Facility I. IDENTIFICATION FACILITY IDN: BEGINNING DATE (MM/DD/YYYY) ENDING DATE (MM/DD/YYYI~ 15 ___~ ~ 021__ ~.r 004006_ ; r10/03/2008 ` ___.._w..~.._. __.w___~ _...._...~ ~..____._~_..~.,,.____ ~ BUSINESS NAME (Same as FACILITY BUSINESS PHONE ({ftlri) ###-kllH# NAME or DBA - Doing Business As) xlf#i!# JIFFY LUBE #1726 - MATT-TY INC. ' (661)859-0183 .........__ ........................_._.___.~.._.____..._........_.__ _.~..._.._._.~ __~.~......,.,....,......_....._~ ____ ~~ ~ __ ....___ .. _ ___ _~; i ..._ ~.._.._ ~ BUSINESS SITE ADDRESS: 3208 CALIFORNIA AVENUE _.____.____.__ _.._._____.__ _ .. . CITY: .. ~ _ . _._ ~ _._._.~ ~_...~..~_....~_~___~_ ~. __.__. BTATE: ZIP CODE: BAKERSFIELD .. _ _._..._ __ . . . _.~.._ ___.... _.........._.... CA 93304 ; : . ... . ... ........._ ..... . ............._.._...__ ___ DUN & BRADSTREET: ~_..._.......... __ ......_._.....__ __ _ _ __.z SIC CODE (4 digit #i): COUNTY: J KERN , BUSINESS OPERATOR NAME:rv~~~rv~~ ~~W„~V gUSINESS OPERATOR PHONE: (###) k#l1-#### xN### PAUL ROKNIPOUR ~(661)993-5844 ~ II. BUSINESS OWNER OWNER NAME: OWNER PHONE: (#ritt) #{t#-#### xN##tl PAUL ROKNIPOUR _..._._..._..~_........~...~~...._.......~.. . . _ . . ._ _____.. _ ~ (661)993-5844 ~ ; . _. ...... . . .... ........................ _ _ OWNER MAILING ADDRESS: ............._.._.__......_.__.................___..._..................................... __................... 37140 25TH STREET EAST CITY: STATE: ZIP CODE: PALMDALE .__._______.___~ CA -T 91550 .__. _ ..__.___~ .,_.___________~ III. ENVIRONMENTAL CONTACT CONTACT NAME: CONTACT PHONE: (If#tl) #!tN-###H ASBURY ENVIRONMENT x#N#N _._._' (800)727-2879 ~ mm~ ~~E CONTACT MAILING ADDRESS: 1300 S. SANTA FE AVENUE ~~~~ ~ CITY: STATE: ~ ~ ~ ZIP CODE: ~ COMPTON _._..___~_..__._..,...~____.__._~ CA ? 90221 [ _..__...._.._~._._,_.~, _~._._~ ____.~..___v.__.__~ IV. EMERGENCY CONTACTS -PRIMARY- -SECONDARY- https://unidocs.ecointeractive.com/user/facility edit.asp?facility id=15-021-004006 12/3/2008 Utlidocs - Uniform Documents NAME: PAUL ROKNIPOUR TITLE: OWNER ..__ _ ~ _...._____~..__. BUSINESS PHONE: (#tlk) tiJtN-###If xkNJi# (661)947~-6202 ~ __..~.~~____....~ 24-HOUR PHONE: (##k) #lik-{t### xNN## (661)993-5844 ~ ~ PAGER#: ADDITIONAL LOCALLY COLLECTED INFORMATION: NAME: JUAN PEREZ ~ TITLE: DM ; BUSINESS PHONE: (#~I!) #k#-iitlk# x#### (661)222-9367 ~.____ ............._......_....~.._. 24-HOUR PHONE: (###) tlk#-Il~ilt# xk#ii# (818)259-5300 µ ~~ PAGER#: ~ ~.. _._.~...._._.__._~ Page 2 of 2 Certification: Based on my inquiry of those individuals responsible for obtaining the information, I certity under penaltyof law that I have personally examined and am familiar with the information submitted and believe the information is true, accurate, and complete. DATE: (MM/DD/YYYY) 10/03/08 NAME OF SIG.~ ~_.~._~~........w. __~._ .__ _~: ~~M ~ NER: JUAN PEREZ NAME OF DOCUMENT PREPARER: ; JUAN PEREZ . __~ ~.~.~_._.__~ _~_._. ~ ___.~ TITLE OF SIGNER: DM ; ~.._.__ ~ _.~ UPCF(1/99 revised) Back._to._Acti...v...ity._Sel_ection. OES FORM 2730 (1 /99) home ~ vy±h.~t'.s._n_e..w... ~ m~rTl.ker.&_ag.en.~ie.5. I~CG.u..ment~_~nd...S~r.~iG.@& I~e.ar~h...unid.4CS I~Q~1t.~Ct...~g relate..d,li.nks ~ tr.a..in~ng a..n..d meetings. For comments or questions regarding the HMIS project, contact the Qnline...QaS~b.ase._Ad..ministr~tqr. hosted by C%~ of_Palo._Aito https://unidocs.ecointeractive.com/user/facility edit.asp?facility id=15-021-004006 12/3/2008