Loading...
HomeMy WebLinkAboutHAZ-ONLINE APPL 12/9/2008Unidocs - Uniform Documents ~i~'~~~~~.:.`~` ~~~~T~i~~1~ ~~~f~~ ~~~~~~~~R~ ~~~.~~~~~~. . _ .. _ . .. . . . P., " , ~~ ' Page 1 of 2 Viewing/Updating Facility Information After modifying the faci lity information below, click 'Update Facility' ta update the database. No Users Have Access to this Facility I. IDENTIFICATION FACILITY IDk: BEGINNING DATE (MM/DD/YYYY) ENDING DATE (MM/DD/YYYI~ 15.._..~. 3 021 .~.._~ ^' 00301.9....,..1 _ ....__ __._.. .._._.< ~___.._.....~..._..._.~_..~..._._____..__._.._._..~ ..~ __-___ ~ # BUSINESS PHONE (#~IN) ###-#~tN# BUSINESS NAME (Same as FACILITY NAME or DBA - Doing Business As) xtiM#tl TMC EXTERMINATORS PEST CONTROL ~ 661 39894 1 9 ; ~ BUSINESS SITE ADDRESS: 640 BELLE TERR _____.__ ~ __ ___~._~_._.-.______ ___ ... ._.~ ~ . _ __ ._ CITY: _~ . _._e_ ~._.~. __~_...._.._~ ~ ~ _~~_. ~_. _______ ~.~.~...~._...~.__...~_ STATE: ZIP CODE: BAKERSFIELD ..............__.......___._......_.......... . . _ .. . . .~ _ . . . . ; CA 93304 ~ ! . _..._. . .. . . .. . _ . . . ... ..... ......._..........._. DUN & BRADSTREET: ......._._....._. ___._.........__...._..................._~_ SIC CODE (4 digit k): < ~ ~ COUNTY: KERN BUSINESS OPERATOR NAME: ~~ ~ BUSINESS OPERATOR PHONE: (N##) Ntlri-#N## xtlll## ___....._ _ _______._.._..___ _~.~_....~._~. , - ____.___: ~.. _____ ..............__.__._.~~ II. BUSINESS OWNER OWNER NAME: OWNER PHONE: (#k#) ##ri-H##ri x#lf## , . _ _..... _........ 6613989419 _.. _ . .... ._ .: __ ....--....... ... . ._ . ...._ OWNER MAILING ADDRESS 6~~~ ~~ CITY: STATE: ~ ~ ZIP CODE: ~BAKERSFIELD~ CA ~ ~ 93386 ~ _ - . ~ __.__. _ _~_. __ _ ____________ __, III. ENVIRONMENTAL CONTACT CONTACT NAME: CONTACT PHONE: (##~i) ti~t11-#It## x#k#li 3 __.... CONTACT MAILING ADDRESS: _„ . ..,_ _....._. 640 BELLE TERR ~~ ~ ~ ~ CITY: STATE: ~ ~ ZIP CODE: ~ _ BAKERSFIELD j .~. _......_. _ ~ r.. ~..~......... ~ CA _ _ .._._~.._. ? 93304 ` ____._~ _.__.-____..._.__..__.___...,,_,....~__..._~._ . ~ IV. EMERGENCY CONTACTS -PRIMARY- -SECONDARY- https://unidocs.ecointeractive.com/user/facility edit.asp?facility id=15-021-003019 12/9/2008 Unidocs - Uniform Documents NAME: TITLE_.... ...,..~ .._.____.._..~_ __. ~____~__.._~._.V.~ ~ ......_.._.__~ __....__ ~ _ ~ BUSINESS PHONE: ##fi ###-##1!# xN~ik# ~ ) ~ _.~.....~.~.._........_..._..__......__......~ 24-HOUR PHONE: (k##) ##!1-##k# xtf##ti ~ _.~~ PAGER#: ; ADDITIONAL LOCALLY COLLECTED INFORMATION: Page 2 of 2 NAME: TITLE: ~._.._._._.,~ ~. _..._....._.m.. 1 ~___~..___. V.. .~_~__ __ _.~_~.._______.____..__~ BUSINESS PHONE: (H#N) #illt-#It#N x###k ~_....._..........._ ......................~ 24-HOUR PHONE: (k#N) k#k-#!tk# x#kM# ~ ____~_~.....~.~ 1 PAGER#: ~ ___.~_ _..._ ~ _~ .,,.._. ......~! 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: 1 TITLE OF SIGNER: ~Tm~~~~_m~~Tmm ~~ a i UPCF(1/99 revised) B.. ack_to. Ac#i...v...ity__Se.lect':on. OES FORM 2730 (1/99) home ~ whaYs_new ~ members._~g.Qncies ~ documents._and._s~rvi.Fe.~ ~ search.unid.p~s ~ cont.a~t._y~ related._links ~ training a.n..d.mee,t.i,ngs For comments or questions regarding the HMIS project, contact the Qn.l.i..n..e._D.~t~.b.a~e_A~mi.n.i.stratpr. hosted by Ci.ty_of_Palo._Alto https://unidocs.ecointeractive.com/user/facility edit.asp?facility id=15-021-003019 12/9/2008