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BUSINESS OWNER/OPERNOR IDENTIFICATION PAGE Page 2 <br /> BUSINESS MAILING AND BILLING INFORMATION <br /> MAILING ADDRESS (41) <br /> If different from Site Address, <br /> otherwise leave blank Street No. Direction Street Name Street Type <br /> NOTE: All official mail <br /> will go to this address <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 NO <br /> ORGANIZATION(43) N Corporation ❑Public Agency NETWORK(44) <br /> ASSESSOR PARCEL NO. (45) 1051-320-09 <br /> PROPERTY OWNER (46) PHONE NO. (47) <br /> NAME COPPERFORD, LLC 209-727-9770 <br /> (If different from Business Owner) <br /> PROPERTY OWNER (48) <br /> ADDRESS 12470 LOCKE ROAD, BLDG. 100 <br /> Street Address <br /> LOCKEFORD CA 95237 <br /> CITY STATE ZIP <br /> FIRE DISTRICT NO. 13 FIRE DISTRICT (49) <br /> NAME MOKELUMNE <br /> NEAREST CROSS (50) <br /> FOCKESTREET RD & STATE HWY 88 <br /> FACILITY (51) NO IF YES, <br /> LOCK BOX WHERE IS IT LOCATED?(52) <br /> NATURE OF BUSINESS (53) WINERY PLAZA <br /> WASTE GENERATOR (54) IYES IF YES, <br /> WHAT IS YOUR EPA NO.?(55) CAL000279170 <br /> TRADE SECRET (56) D SPILL PREVENTION YES(57) <br /> INFORMATION NO 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 <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 /> DATE REC'D: <br />