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UNIFIED PROGRAM CONSOLIDATED FORM <br /> FACILITY INFORMATION <br /> BUSINESS OWNER/OPERATOR IDENTIFICATION,PAGE 2 <br /> LOCALLY COLLECTED INFORMATION <br /> (05/26/2009-02:23:02 PM) <br /> TYPE OF 138 UNSTAFFED SITE NETWORK 139 <br /> ORGANIZATION ❑Single Owner [3 Partnership <br /> ®Corporation ❑Public Agency NO <br /> ASSESSOR PARCEL NUMBER 140 NEAREST CROSS STREET 141 <br /> NA INDUSTRIAL <br /> PROPERTY OWNER NAME(If different from Business Owner) 142 PHONE NO. 143 <br /> C&S WHOLESALE GROCERS,INC. 6036546429 <br /> PROPERTY OWNER STREET ADDRESS 144 PROPERTY OWNER CITY 145 STATE 146 ZIP CODE 147 <br /> 7 CORPORATE DRIVE KEENE NH 03431 <br /> FIRE DISTRICT NAME 148 FIRE DEPT NO. 149 FACILITY LOCK BOX 150 IF YES,WHERE IS IT LOCATED? 151 <br /> STOCKTON FIRE DEPARTMENT 22 YES MAIN GATE <br /> NATURE OF BUSINESS 152 <br /> GROCERY WAREHOUSE AND DISTRIBUTION CENTER <br /> WASTE GENERATOR 153 1 IF YES,ENTER EPA NUMBER 154 <br /> YES CAL000182825 <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,datc(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 BILLING CITY 159 STATE 160 ZIP CODE 161 <br /> This area intentionally left blank <br />