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BUSINESS OWNER/OPERATOR IDENTIFICATION PAGE Page 2 <br /> BUSINESS MAILING AND BILLING INFORMATION <br /> MAILING ADDRESS [=== P.O. BOX 1700 <br /> If different from Site Address, <br /> otherwise leave blank Street No. Direction Street Name Street Type <br /> NOTE: All official mail <br /> will go to this address IONE CA 95640 <br /> City State ZIP <br /> BILLING ADDRESS(42) <br /> If different from Mailing II <br /> Address,otherwise leave blank Street No. Direction Street Name Street Tvpe <br /> City State ZIP <br /> ADDITIONAL BUSINESS INFORMATION <br /> TYPE OF ❑Single Owner ®Partnership UNSTAFFED SITE <br /> ORGANIZATION(43) ❑Corporation ❑Public Agency NETWORK(44) NO <br /> ASSESSOR PARCEL NO. (45) <br /> 019-070-20 <br /> PROPERTY OWNER (46) PHONE NO. (47) <br /> NAME JOANN SEMAS 209.607-7787 <br /> (If different from Business Owner)[ <br /> PROPERTY OWNER (48) <br /> ADDRESS 114088 E HWY 88 <br /> Street Address <br /> LOCKEFORD CA 95237 <br /> CITY STATE 7_IP <br /> FIRE DISTRICT NO. 13 FIRE DISTRICT (49) <br /> NAME LOCKEFORD <br /> NEAREST CROSS (50) <br /> STREET CHERRY <br /> FACILITY (51) NO IF YES, <br /> LOCK BOX WHERE IS IT LOCATED?(52) NA <br /> NATURE OF BUSINESS (53) <br /> RESTAURANT <br /> WASTE GENERATOR (54) NO IF YES, <br /> WHAT IS YOUR EPA NO.?(55)INA <br /> TRADE SECRET (56) SPILL PREVENTION (57) <br /> INFORMATION NO AND COUNTERMEASURES NO <br /> PLAN FOR THIS FACILITY <br /> TRAIlVING PROGRAM INFORMATION <br /> Does your business have an employee training program that includes initial training and annual refreshers'? (58) YES <br /> Does your business maintain written training records that show the training subject,date(s)of training, (59) YES <br /> names and signatures of employees trained,and names of instructor(s)? <br /> DATE REC'D: 9/10/07 <br />