HomeMy WebLinkAbout4300 ASHE ROAD #110~'~~~~~~~~ ~~~~~'~~~~~ ~,N~~~~~~" ~~~~~~~~ s~~~Q~~~~.
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FACILITY USERS
Name Phone Number Email
Kevin..._M....c...Neil 559-292-9729 k._mcnLa~netzero..com
I. IDENTIFICATION
FACILITY IDN: BEGINNING DATE (MM/DD/YYYY) ENDING OATE (MM/DD/YYYY)
15 ~ 021 ~j~ 004008 ~- _ µ~f ~ ~
BUSINESS PHONE (tf#il) ##~l-1fHlt#
BUSINESS NAME (Same as FACILIN NAME or DBA - Doing Business As) xlf#ti#
Merry X-Ray Corp. ; '-
BUSINESS SITE ADDRESS:
4300 Ashe Road, Suite 110
_._.~~.._._..~......._ .................._........._.._....._... _............_........_..__......_....._....._....._........._~.~.................._..._....._......_.........._._..._.......__...._ ______.._.~................... _.........._.............._.......__.._....
CITY: STATE: ZIP CODE:
Bakersfield CA 93313
__._.____..___. ~.....__._....~___.__.__..~ .~.___~__....~; ._ ~....__. _~.._....~
DUN & BRADSTREET: SIC CODE (4 digit #):
; __.. _ .l
COUNTY:
Kern
BUSINESS OPERATOR NAME: BUSINESS OPERATOR PHONE: (##ti) lt#q-If##~l xllk##
;
;
.............................~___""__.~...,...~.,.._.,,__~.~____._.._....~_.........J
II. BUSINESS OWNER
OWNER NAME: OWNER PHONE: (rik#) ##q-Hriiik x##H#
.._ ___.._..V..__.__~___ ____._..~_._. __. ,_.__.~_ _ __..____ ~_._.__ ~_~_...__________1
OWNER MAILING ADDRESS:
_ _... . _ ........ .....:
CITY: STATE: ZIP CODE.
_.____~____.__ __ .....,._._.~......... ~ ~ ,.._..._._! „__._.__.~._.~.~_._..________~
III. ENVIRONMENTAL CONTACT
CONTACT NAME: CONTACT PHONE: (#Hlt) N#tl-fftik#
xtilf#It
;
>
_ .~...__._~.__..._ ~,........._ ~~ .~ ~__: ~
_~.._.__ _..__.______.__,_,._._......_.....~_.._._~_
CONTACT MAIL~NG ADDRESS:
_. :
CITY: STATE: ZIP CODE:
.___ __m__~ I r _______.~.~
https://unidocs.ecointeractive.com/user/facility edit.asp?facility id=15-021-004008 12/3/2008
'' Unidocs - Uniform Documents
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IV. EMERGENCY CONTACTS
-PRIMARY-
NAME:
TITLE:
BUSINESS PHONE: (Nqii) N#~-t~tili# x###~
,
._...._.._.____.._..........._._..._......_..__.._.....___ ............... 3
24-HOUR PHONE: (k##) ##~l-##k# x###N
~
~ m~
PAGERti:
~ ~. ~
~_..______ .~
ADDITIONAL LOCALLY COLLECTED INFORMATION:
-SECONDARY-
NAME:
3
TITLE:
~
BUSINESS PHONE: (ti#~t) k#H-###~ x#illtM '
~ _._._....__........~.._ ...............~.___~._.._..._..I
24-HOUR PHONE: (ttk#) k#fi-#k#k x#ilk#
~ ~~....J
PAGERN:
~ _..~ _~___~___~~
Certification: Based on my inquiry of those individuals responsible for obtaining the information, I certify 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)
NAME OF SIGNER: ~~ ~T"T
NAME OF DOCUMENT PREPARER:
~
TITLE OF SIGNER: ~ J
UPCF(1/99 revised)
Back._to._Acti...v...ity._Sel_ection.
OES FORM 2730 (1 /99)
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https://unidocs.ecointeractive.com/user/facility edit.asp?facility id=15-021-004008 12/3/2008