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do <br /> -� SINESS OWNER/OPERATOR IDENTIFICATION FOR SIDE 2 <br /> g�P BUSINESS MAILING AND BILLING INFORMATION <br /> v <br /> MAILI t iC VFOS(41) <br /> (If de KL Site Address) <br /> NO All ti sensitive and Street No. Direction Ell Street Name Street Type <br /> official co 0ence will <br /> be sentA V°addr s <br /> r�T1K CITY STATE ZIP <br /> � <br /> ING ADDRFSy42) <br /> di ��Q^�„ <br /> includrmation <br /> �O <br /> ADDITIONAL, BUSINESS INFORMATION <br /> TYPE OF ❑Single Owner ❑Partnership UNSTAFFED SITE NETWORK(44) �yES �NO <br /> ORGANIZATION (43) Corporation ❑Public Agency <br /> ASSESSOR PARCEL NO. (45) ;7 /-7 07 - /,Jr� 71 <br /> PROPERTY OWNER (46) PHONE NO.(47) <br /> NAME <br /> (If different from Business Owner) <br /> PROPERTY OWNER (48) <br /> ADDRESS <br /> Street Address <br /> CITY STATE ZIP <br /> FIRE DISTRICT (49) ,pp <br /> NEAREST CROSS (50) <br /> STREET A// <br /> p <br /> FACILITY (51) IF YES, <br /> LOCKBOX �� WHERE IS IT LOCATED?(52) '4�YI;S NO <br /> NATURE OF BUSINESS (53) <br /> WASTE GENERATOR (54) IF YES, <br /> -F,S ❑NO WHAT IS YOUR EPA NO.?(55)Ictnt-006 115--07-300 <br /> TRADE SECRET 156) SPILL PREVENTION (57) <br /> INFORMATION AND COUNTERMEASURES <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 ❑NO <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)? YES NO <br /> 12100 <br />