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ANUL <br /> BUSINESS OWNER/OPER OR IDENTIFICATION PAGE Page 2 <br /> BUSINESS MAILING AND BILLING INFORMATION <br /> MAILING ADDRESS (41) <br /> If different from Site Address, O.BOX 690514 <br /> otherwise leave blank Street No. Direction Street Name Street Type <br /> NOTE: All official mail <br /> will go to this address TOCKTON CA <br /> City State ZI I' <br /> BILLING ADDRESS 16500 ARLAN <br /> If different from Mailing <br /> Address,otherwise leave blank treet No. Direction Street Name Street type <br /> ATHROP 5330 <br /> City State ZIP <br /> ADDITIONAL BUSINESS INFORMATION <br /> TYPE OF ®Single Owner ❑Partnership UNSTAFFED SITE O <br /> ORGANIZATION(43) El Corporation ❑Public Agency NETWORK(44) <br /> ASSESSOR PARCEL NO.(45) <br /> 198-210.17 <br /> PROPERTY OWNER (46) PHONE NO.(47) <br /> NAMEICK ARBABIAN 81-293-1000 <br /> (If different from Business Owner <br /> PROPERTY OWNER (48) <br /> ADDRESS P.O. BOX 690514 <br /> Street Address <br /> STOCKTON CA 5269-0514 <br /> CITY STATE ZIP <br /> FIRE DISTRICT NO. 37 NAMDISTRICT (49) ILATHROP/MANTECA <br /> NEAREST CROSS (50) <br /> STREET I-5 <br /> FACILITY (51) IF YES, /A <br /> LOCK BOX WHERE IS IT LOCATED?(52) <br /> NATURE OF BUSINESS (53) <br /> AS STATION & SNACK SHOP <br /> WASTEGENERATOR (54) IF YES, <br /> / WHAT IS YOUR EPA NO.?(55) /A <br /> TRADE SECRET (56) SPILL PREVENTION (57) <br /> INFORMATIONNO 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) ES <br /> Does your business maintain written training records that show the training subject,date(s)of training, (59) <br /> names and signatures of employees trained,and names of instructor(s)? ES <br /> DATE REC'D: 10/5/07 <br />