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UNIFIED PROGRAM CONSOLIDATED FORM <br /> FACILITY INFORMATION <br /> BUSINESS OWNER/OPERATOR IDENTIFICATION,PAGE 2 <br /> LOCALLY COLLECTED INFORMATION <br /> (06/02/2010- 10:55:44 AM) <br /> A E NETWORK I3 <br /> ORGANIZATION ❑Single Owner ❑Partnership <br /> ®Corporation [I Public Agency NO <br /> ASSESSOR PARCEL NUMBER 140 NEAREST CROSS STREET 141 <br /> 051-320-09 E LOCKE RD&STATE HWY 88 <br /> PROPERTY OWNER NAME(If different from Business Owner) 142 1 PHONE NO. 143 <br /> COPPERFORD,LLC 209-727.9770 <br /> PROPERTY OWNER STREET ADDRESS 144 PROPERTY OWNER CITY 14 STATE 146 ZIPCODE I47 <br /> 12470 LOCKE ROAD,BLDG.100 LOCKEFORD CA 95237 <br /> FIRE DISTRICT NAME 11 FIRE DEPT NO.14 FACILITY LOCK BOX 15 IF YES,WHERE IS IT LOCATED? 151 <br /> MOKELUMNE 13 NO <br /> NATURE OF BUSINESS 152 <br /> WINERY PLAZA <br /> WASTE GENERATOR 153 1 IF YES,ENTER EPA NUMBER 154 <br /> YES CAL000279170 <br /> TRADE SECRET INFORMATION 155 SPILL PREVENTION AND COUNTERMEASURES PLAN PREPARED FOR FACILITY? 156 <br /> NO YES <br /> TRAINING PROGRAM INFORMATION 157 <br /> Does your business have an employee training program that includes initial training and annual refreshers? YES <br /> Does your business maintain written training records that show the training subject,date(s)of training, YES <br /> names and signatures of employees trained,and names of instructor(s)? <br /> BILLING ADDRESS If different from Mailing Address,otherwise leave blank <br /> BUSINESS BILLING ADDRESS 158 <br /> BUSINESS BILLING CITY 159 STATE 160 ZIP CODE 161 <br /> This area intentionally left blank <br />