Laserfiche WebLink
RECEIVED <br /> UNIFIED PROGRAM CONSOLIDATED FORM MM 2 1 009 <br /> FACILITY INFORMATION <br /> BUSINESS OWNER/OPERATOR IDENTIFICATION,PAGE 2 SAN JOAQUIN OUNTY <br /> LOCALLY COLLECTED INFORMATION OFFICE OF EMERGE1 ICY SERVICES <br /> (05/05/2009-08:26:37 AM) <br /> TYPE OF 138 UNSTAFFED SITE NETWORK 139 <br /> ORGANIZATION ❑Single Owner ❑Partnership <br /> ®Corporation [IPublic Agency YES <br /> ASSESSOR PARCEL NUMBER 140 NEAREST CROSS STREET 141 <br /> 019-120-05 NORTH SIERRA DRIVE <br /> PROPERTY OWNER NAME(If different from Business Owner) 142 1 PHONE NO. 141 <br /> CHARLES&MARCIA BECKMAN N/A <br /> PROPERTY OWNER STREET ADDRESS 144 PROPERTY OWNER CITY 145 STATE146 ZIP CODE 147 <br /> N/A N/A N/A N/A <br /> FIRE DISTRICT NAME 148 FIRE DEPT NO.149 FACILITY LOCK BOX 150 IF YES,WHERE IS IT LOCATED? 151 <br /> MOKELUMNE 13 NO N/A <br /> NATURE OF BUSINESS 152 <br /> TELECOMMUNICATIONS <br /> WASTE GENERATOR 153 IF YES,ENTER EPA NUMBER 154 <br /> NO N/A <br /> TRADE SECRET INFORMATION 155 SPILL PREVENTION AND COUNTERMEASURES PLAN PREPARED FOR FACILITY? 156 <br /> NO NO <br /> TRAINING PROGRAM INFORMATION 15- <br /> Does <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)? <br /> BILLING ADDRESS If different from Mailing Address,otherwise leave blank <br /> BUSINESS BILLING ADDRESS 158 <br /> BUSINESS BILLLING CITY 159 STATE 160 ZIP CODE 16I <br /> This area intentionally left blank <br />