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f -.b-Z)9 <br /> BUSINESS OWNER/OPERATOR IDENTIFICATION PAGE Page 2 <br /> BUSINESS MAILING AND BILLING INFORMATION <br /> MAILING ADDRESS (4I) 100 CUMBERLAND SUITE 1700 LVD <br /> If different from Site Address, <br /> otherwise leave blank Street <br /> NOTE:All official mail No. Direction Street Name Street Type <br /> will go to this address TLANTA GA 0339 <br /> City State ZIP <br /> BILLING ADDRESS (42) <br /> If different from Mailing <br /> Address,otherwise leave blank Street No. Direction Street Name Street Type <br /> City State ZIP <br /> ADDITIONAL BUSINESS INFORMATION <br /> TYPE OF ❑Single Owner ❑Partnership UNSTAFFED SITE O <br /> ORGANIZATION (43) IN Corporation El Public Agency NETWORK(44) <br /> ASSESSOR PARCEL NO.(45) <br /> 1177-330-20 <br /> PROPERTY OWNER (46) PHONE NO.(47) <br /> NAMEARRY ULMAN 10-375-7052 <br /> (If different from Business Owner <br /> PROPERTY OWNER (48) <br /> ADDRESS IBLACKSTONE PLAZA,P.O.BOX 1352 <br /> Street Address <br /> ORRENCE CA 0505 <br /> CITY STATE ZIP <br /> FIRE DISTRICT NO. 09 FIRE DISTRICT (49) <br /> L!L7_J NAME ISTOCKTON FIRE DISTRICT <br /> NEAREST CROSS (50) <br /> STREET STREET <br /> FACILITY (51) IF YES, <br /> LOCK BOX WHERE IS IT LOCATED?(52) <br /> NATURE OF BUSINESS (53) <br /> ISTRIBUTES FASTENERS,ANCHORS,BOLTS,CHAINS,ETC <br /> WASTE GENERATOR (54) ES IF YES, <br /> WHAT IS YOUR EPA NO:?(55) 1CAL000304053 <br /> TRADE SECRET (56) SPILL PREVENTION (57) <br /> INFORMATION NO AND COUNTERMEASURES NO <br /> PIAN 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: <br />