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BUSINESS OWNER/OPERATOR IDENTIFICATION PAGE <br /> DATEREC'D 1/19/01 <br /> BUSINESS MAILING AND BILLING INFORMATION <br /> MAILING ADDRESS 1400 � SPRINGS ROAD <br /> If different from Site Address <br /> NOTE: All time sensitive and Street No. Direction Street Name Street Type <br /> official correspondence will be VALLEJO <br /> sent to this address CA 94591 <br /> CITY STATE ZIP <br /> BILLING ADDRESS(42) C/O PRB MANAGEMENT LLC <br /> If different from above; 1400 SPRINGS RD <br /> include"Care of information VALLEJO, CA 94591 <br /> ADDITIONAL BUSINESS INFORMATION <br /> TYPE OF ®Single Owner ❑Partnership UNSTAFFED SITE NO <br /> ORGANIZATION(43) ❑ Corporation ❑Public Agency NETWORK(44) <br /> ASSESSOR PARCEL NO. (45) <br /> 1071-180-19 <br /> PROPERTY EOWNER (46) BASRA ENT PHONE NO. (47) <br /> 707-557-1198 <br /> (If different from Business Owner) <br /> PROPERTY OWNER (48) <br /> ADDRESS 1400 SPRINGS RD <br /> Street Address <br /> VALLEJO CA 94591 <br /> CITY STATE ZIP <br /> FIRE DISTRICT NO. ❑ FIRE DISTRICT (49) <br /> NAME FTWCKTON FD <br /> NEAREST CROSS (50) <br /> STREET INTERSTATE 5 <br /> FACILITY (51) NO IF YES, <br /> LOCK BOX D WHERE IS IT LOCATED?(52) <br /> NATURE OF BUSINESS (53) FAST FOOD RESTAURANT <br /> WASTE GENERATOR (54) IF YES, <br /> WHAT IS YOUR EPA NO.?(55) <br /> TRADE SECRET (56) D SPILL PREVENTION (57) <br /> INFORMATION AND COUNTERMEASURES <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 />