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BUSINESS OWNER/OPERATOR IDENTIFICATION PAGE Page 2 <br /> BUSINESS MAILING AND BILLING INFORMATION <br /> TILING ADDRESS(41) 1210 VERA <br /> KdAVE <br /> ifferent from Site Address, <br /> otherwise leave blank Street No. Direction Street Name Street Type <br /> NOTE: All official mail RIPON CA 95366 <br /> will go to this address <br /> City State ZIP <br /> BILLING ADDRESS (42) 259 WILMA A V E <br /> If different from Mailing <br /> Address,otherwise leave blank Street No. Direction Street Name Street Type <br /> RIPON CA 95366 <br /> City State ZIP <br /> ADDITIONAL BUSINESS INFORMATION <br /> TYPE OF ❑Single Owner ❑Partnership UNSTAFFED SITE YES <br /> ORGANIZATION(43) ❑ Corporation H Public Agency NETWORK(44) <br /> ASSESSOR PARCEL NO. (45) 1259-020-62 <br /> PROPERTY OWNER (46) PHONE NO.(47) <br /> NAME CITY OF RIPON 209-599-2151 <br /> (If different from Business Owner) <br /> DROPERTY OWNER (48) <br /> �..tDRESS 259 N WILMA AVE <br /> Street Address <br /> RIPON CA 95366 <br /> CITY STATE ZIP <br /> FIRE DISTRICT NO. F7 FIRE DISTRICT (49) <br /> NAME RIPON <br /> NEAREST CROSS (50) SEVENTH ST <br /> STREET <br /> FACILITY (51) NO IF YES, NA <br /> LOCK BOX WHERE IS IT LOCATED?(52) <br /> NATURE OF BUSINESS (53) <br /> CITY WELL SITE <br /> WASTE GENERATOR (54) NO IF YES, <br /> WHAT IS YOUR EPA NO.?(55) NA <br /> TRADE SECRET (56) D SPELL PREVENTION (57) <br /> INFORMATION NO AND COUNTERMEASURES NO <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 /> �es 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 /> DATEREC'D: 1/16/04 <br />