HomeMy WebLinkAboutHAZ-ONLINE INVEN. 12/30/2008iJnidocs - Uniform Documents Page 1 of 2
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H~~~~;d~~;~ ~I~x~ri~al~ ~~ nlir~~ ~r~~~r,~tc~~y Pr~,4j~~t
Viewing/Updating Facility Information
After modifying the faci lity information below, click 'Update Facility' to update
the database.
FACILITY USERS
Name Phone Number Email
Krista Brown 760-602-8700 regulatory~,a~3ecompany.com
I. IDENTIFICATION
FACILITY ID#: BEGINNING DATE (MM/DD/YYYY) ENDING DATE (MM/DD/YYW)
, 5 ... 0?, ~~ ~~4~2, _ ~ --__._....__._.~.~ r2,3„2~09 ___~____.~
BUSINESS PHONE (#1f#) ###-####
BUSINESS NAME (Same as FACILITY NAME or DBA - Doing Business As) X~
Walgreens #1816 _ ____~ ____~~ (661) 835-9385 _~
BUSINESS SITE ADDRESS:
3301 Panama Lane_____~_.._ .
~
CITY: ______.__.
_____._._ _ .~.__._~,~.___.._._____._._..
STATE: ~ZIP CODE:
Bakersfield ~ CA 93313
~
=
DUN & BRADSTREET: ___
SIC CODE (4 digit #):
93-103-6651
...~._____..__._
.___
~ 5912, 7384 ~
~
,
__
_
COUNTY: ___..
____....~_._ __~__._.._
Kern ~
BUSINESS OPERATOR NAME: BUSINESS OPERATOR PHONE: (#/k#) ###-#### x####
Steve Smith
_ ._._. ______.__.. 661 835-9383
__~ ~ ~.~.~..~.____.~
II. BUSINESS OWNER
OWNER NAME: OWNER PHONE: (#1t#) #ItJ#-#~tFt~ x#1~##
Walgreens Corporation ~~~ ~~ (847) 914-2264 ~
OWNER MAILING ADDRESS:
200 Wilmot Rd. ~~ MSZ ~ 1 1 _~4
_
__
.
~
v
CITY: ~
__
_.~_______
_.__..___~___.__._~~.__
STATE: ZIP CODE:
Deerfield i~ IL _ ~~ 60015 ."._~_~__~`~~
III. ENVIRONMENTAL CONTACT
CONTACT NAME: CONTACT PHONE: (#N#) ###-#l~##
x##1##
3E Company, Go Regulatory Department ~^ j (760) 602-8700 ~
CONTACT MAILING ADDRESS:
1905 Aston Ave~
_ ~
____.____.
__,_
CITY: ____ _ ___.~_~.____._M__,.____.__.__ _____..
STATE: ~ ZIP CODE:
Carlsbad ~ CA ~ 92008 ~
https://unidocs.ecointeractive.com/user/facility_edit.asp?facility_id=15-021-004021 12/30/2008
L~nidocs - Uniform Documents
Page 2 of 2
IV. EMERGENCY CONTACTS
-PRIMARY-
NAME:
Steve Smith~ ~~ ~ry ~~ ~
TITLE:
Store Manager ~
BUSINESS PHONE: (#~{#) ~ x####
(661) 835-9383 ;
24-HOUR PHONE: (###) #k#-#~}# x####
(661) 663-0995 ~~ (
PAGER#:
N/A ~ ~4j
ADDITIONAL LOCALLY COLLECTED INFORMATION:
-SECONDARY-
NAME:
Carlo Dias _.___._____.______.___._..~
TITLE:
Area Photo Supervisor ~~
BUSINESS PHONE: (###) ###-#tk## ~t
(916) 889-6821 ~
24-HOUR PHONE: (#1x#) ###-#q#!# x####
(916) 889-6821 ~~
PAGER#:
N/A .~~__.__.~_._.._.~
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 infortnation submitted and believe the information is true, accurate,
and complete.
DATE: (MM/DD/YYW)
, Ziosi2oos .~______.___J
NAME OF SIGNER:
Sean Nix, Agent for Walgreens C;
NAME OF DOCUMENT PREPARER:
Sean Nix, Agent for Walgreens C~.
TITLE OF SIGNER:
Associate Regulatory Specialist ~
Upda e~Facility
~, ~.,.M~,~,~~.~r~ ~~
UPCF(1/99 revised)
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