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DEC 1 91003 <br /> BUSINESS OWNER/OPERITOR IDENTIFICATION PAGE Page 2 <br /> BUSINESS MAILING AND BILLING INFORMATION <br /> MAILING ADDRESS(41) 730 7 BECKMAN <br /> If different from Site Address, RD <br /> otherwise leave blank Street No. Direction Street Name Street Type <br /> NOTE: All official mail LODI <br /> will go to this address CA 95240 <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 OFrN <br /> ingle Owner ❑Partnership UNSTAFFED SITE NO <br /> ORGANIZATION(43) Corporation ❑Public Agency NETWORK(44) <br /> ASSESSOR PARCEL NO. (45) <br /> 1215-660-12-7 <br /> PROPERTY OWNER (46) PHONE NO. (47) <br /> NAME DONALD W. FOWLER 209-339-0791 <br /> (If different from Business Owner) <br /> PROPERTY OWNER (48) <br /> ADDRESS 730 S. BECKMAN RD. STE B <br /> Street Address <br /> LODI CA 95240 <br /> CITY STATE ZIP <br /> FIRE DISTRICT NO. FIRE DISTRICT (49) <br /> NAME CITY OF MANTECA <br /> NEAREST CROSS (50) LOUISE AVE/MAIN ST <br /> STREET <br /> FACILITY (51) NO IF YES, <br /> LOCK BOX WHERE IS IT LOCATED?(52) <br /> NATURE OF BUSINESS (53) <br /> QUICK LUBE <br /> WASTE GENERATOR (54) Y,S IF YES, CAL000011032 <br /> WHAT IS YOUR EPA NO.. (55) <br /> TRADE SECRET (56) SPILL PREVENTION (57) <br /> INFORMATION NO AND COUNTERMEASURES YES <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) NO <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: 12/19/03 <br />