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UNIFIED PROGRAM CONSOLIDATED FORM <br /> FACILITY INFORMATION <br /> BUSINESS OWNER/OPERATOR IDENTIFICATION,PAGE 2 <br /> LOCALLY COLLECTED INFORMATION <br /> (03/22/2011 - 11:23:38 AM) <br /> ORGANIZATION ❑Single Owner ®Partnership <br /> ❑Corporation ❑Public Agency NO <br /> ASSESSOR PARCEL NUMBER 140 NEAREST CROSS STREET 141 <br /> 019-070-20 CHERRY <br /> PROPERTY OWNER NAME(If different from Business Owner) 142 1 PHONE NO, 143 <br /> JOANN SEMAS 209-607-7787 <br /> PROPERTY OWNER STREET ADDRESS 144 PROPERTY OWNER CITY 145 STATE 146 ZIP CODE 147 <br /> 14088 E HWY 88 LOCKEFI CA 95237 <br /> FIRE DISTRICT NAME 148 FIRE DEPT'NO. 149 FACILITY LOCK BOX IS IF YES,WHERE IS IT LOCATED? 151 <br /> LOCKEFORD 13 NO NA <br /> NATURE OF BUSINESS 152 <br /> RESTAURANT <br /> WASTE GENERATOR 153 1 IF YES,ENTER EPA NUMBER 154 <br /> NO NA <br /> TRADE SECRET INFORMATION 155 SPILL PREVENTION AND COUNTERMEASURES PLAN PREPARED FOR FACILITY? 156 <br /> NO NO <br /> TRAINING PROGRAM INFORMATION 157 <br /> Does your business have an employee training program that includes initial training and annual refreshers? YES <br /> Does your business maintain written training records that show the training subject,date(s)of training, YES <br /> names and signatures of employees trained,and names of instructor(s)9 <br /> BILLING ADDRESS If different from Mailing Address,otherwise leave blank <br /> BUSINESS BILLING ADDRESS 158 <br /> BUSINESS BILLING CITY 159 STATE 1611ZIP CODE 161 <br /> This area intentionally left blank <br />