Laserfiche WebLink
r <br /> UNIFIED PROGRAM CONSOLIDATED FORM <br /> FACILITY INFORMATION <br /> BUSINESS OWNER/OPERATOR IDENTIFICATION,PAGE 2 <br /> LOCALLY COLLECTED INFORMATION <br /> (05/07/2009- 12:03:45 PM) <br /> TYPE OF 138 UNSTAFFED SITE NETWORK 139 <br /> ORGANIZATION ā¯‘Single Owner [IPartnership <br /> ®Corporation [I Public Agency NO <br /> ASSESSOR PARCEL NUMBER 140 NEAREST CROSS STREET 141 <br /> 153-030-35 WILSON WAY <br /> PROPERTY OWNER NAME(If different from Business Owner) 142 1 PHONE NO. 143 <br /> BRYAN HARTER 408-255-6026 <br /> PROPERTY OWNER STREET ADDRESS 144 PROPERTY OWNER CITY 145 STATE 146 ZIPCODE 147 <br /> PO BOX 3322 SARATt CA 95070 <br /> FIRE DISTRICT NAME 148 FIRE DEPT NO. 149 FACILITY LOCK BOX 150 IF YES,WHERE IS IT LOCATED? 151 <br /> STOCKTON 606E NO NA <br /> NATURE OF BUSINESS 152 <br /> AUTO REPAIR <br /> WASTE GENERATOR 153 1 IF YES,ENTER EPA NUMBER 154 <br /> NO NA <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 />