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BUSINESS OWNER/OPERATOR IDENTIFICATION PAGE Page 2 <br /> BUSINESS MAILING AND BILLING INFORMATION <br /> MAILING ADDRESS(4 1) 3851 FREEWAY BLVD <br /> If different from Site Address, <br /> otherwise leave blank Street No. Direction Street Name Street Type <br /> NOTE:All official mail will <br /> go to this address SACRAMENTO CA 195834 <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 YES <br /> ORGANIZATION(43) IN Corporation ❑Public Agency I <br /> NETWORK(44) <br /> ASSESSOR PARCEL NO. (45) <br /> 105-030-04 <br /> PROPERTY OWNER (46) PHONE NO.(47) <br /> NAME RICHARD & MELANIE BRANDSTAD <br /> (If different from Business Owner) <br /> PROPERTY OWNER (48) <br /> ADDRESS 11320 E EIGHT MILE RD <br /> Street Address <br /> ISTOCKTON CA 195212 <br /> City State ZIP <br /> FIRE DISTRICT NO. FIRE DISTRICT (49) LINDEN <br /> NAME <br /> NEAREST CROSS (50) <br /> STREET 1HWY 26 &JACK TONE RD <br /> FACILITY (51) NO IF YES, N/A <br /> LOCK BOX WHERE IS IT LOCATED?(52) <br /> NATURE OF BUSINESS (53) <br /> TELECOMMUNICATIONS <br /> WASTE GENERATOR (54) NO IF YES, <br /> WHAT IS YOUR EPA NO.?(55) N/A <br /> TRADE SECRET (56) SPILL 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 /> 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 />