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UNIFIED PROGRAM CONSOLIDATED FORM FACTLITV INFORMATION BUSINESS OWNER/OPERATOR IDENTIFICATION, PAGE 2 LOCALLY COLLECTED INFORMATION TYPE OF138 TINSTAFFFn STTFNFTWnRK 139 �On IT I A Il�* ❑ Single Owner ® Corporation ❑Partnership NO ARSRSSOR PAR(PI.NIIMRRR 140 NEAREST CROSS STREET 141 179-250-18,19,20,25,27 HIGHWAY 99 FRONTAGE ROAD PROPERTY OWNER NAME(If different from Business Owner) 142 PHONE NO. 143 IMPERIAL VENTURE,LP (323)295-2000 PROPERTY OWNER STREET ADDRESS 144 PROPERTY OWNER CITY 145 STATE 146 ZIP CODE 147 5120 WEST GOLDLEAF CIRCLE,SUITE 300 LOS ANGELES CA 90056 FIRE DISTRICT NAME 148 FIRE DEPT NO. 149 FACILITY LOCK BOX 150 IF YES,WHERE IS IT LOCATED? 151 STOCKTON 830A YES ABOVE FRONT DOOR N ATI TRF nF RI ISTNFSS 152 COLD STORAGE&DISTRIBUTION OF FOOD WASTE GENERATOR 153 1 IF YES.ENTER EPA NUMBER 154 YES CAL000367386 TR AnF sF.C'.RF.T TNFnRMATTnN 155 SPILL PREVENTION AND COI INTFRMEASURES PLAN PREPARED FOR FACILITY? . 156 NO YES TRAINING PROGRAM INFORMATION I�57 n...,.....,.._,.....:..,,_,.,,........_ .......,_..........:..:......_...._.._.w...:.._,..a..,.:..:«,.i._..:_:........a...._....,_..a.....,.,,_.n YES Does your business maintain written training records that show the training subject,date(s)of training, YES .........J.:......... ......C.....a..........._..:--A --A.............C:....a...... _ran RILLTNn A"DRRRR if diffnrrnt from Mnnino Addrncc.ntharwicn Iravr hN.1, BUSINESS BILLING ADDRESS 158 BUSINESS BILLING CITY 159 STATE 160 ZIP CODE 161 This area intentionally left blank