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0 • <br /> BUSINESS OWNER/OPERATOR IDENTIFICATION PAGE Page 2 <br /> BUSINESS MAILING AND BILLING INFORMATION <br /> MAILING ADDRESS(4I) 633 VICTOR RD <br /> If different from Site Address, <br /> otherwise leave blank Street No. Direction Street Name Street Type <br /> NOTE: All official mail goes LODI CA 95240 <br /> will go to this address <br /> City State ZIP <br /> BILLING ADDRESS(42) <br /> If different from Mailing <br /> Address,otherwise leave blank Street No. Direction Street Name Street Type <br /> City State <br /> � ZIP <br /> ADDITIONAL BUSINESS INFORMATION <br /> TYPE OF ❑ Ingle Wner ®Partnership UNSTAFFED SITE NO <br /> ORGANIZATION(43) ❑Corporation ❑Public Agency NETWORK(44) <br /> ASSESSOR PARCEL NO. (45) 051-300-21 <br /> PROPERTY OWNER (46) PHONE NO. (47) [209=-367-7693 <br /> NAME KNOX & ASSOCIATES <br /> (If different from Business Owner) <br /> PROPERTY OWNER (48) <br /> ADDRESS 633 E VICTOR RD <br /> Street Address <br /> LODI CA 95240 <br /> CITY STATE ZIP <br /> FIRE DISTRICT NO. 13 FIRE DISTRICT (49) MOKELUMNE FD <br /> NAME <br /> NEAREST CROSS (50) BRANT RD <br /> STREET <br /> FACILITY (51) NO IF YES, <br /> LOCK BOX WHERE IS IT LOCATED?(52) N/A <br /> NATURE OF BUSINESS (53) FAST FOOD <br /> WASTE GENERATOR (54) NO IF YES, <br /> WHAT IS YOUR EPA NO.?(55) N/A <br /> TRADE SECRET (56) SPILL PREVENTION (57) <br /> INFORMATION N/A AND COUNTERMEASURES N/A <br /> PLAN FOR THIS FACILITY <br /> TRAINING 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: 12/27/02 <br />