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-41-TBUSINESS OWNER/OPERATOR IDENTIFICATION FORM SIDE 2 <br /> MAILING ADDRESS <br /> BUSINESS MAILING AND BILLING INFORMATION <br /> � <br /> (If different from Site Address) <br /> ss) = <br /> NOTE: All time sensitive and Street No. Direction Street Name Street Type <br /> official eorzespondet3ill <br /> be sent[wthis�addre5,� <br /> 90 CITY STATE <br /> BILfe 9r31y FEB 1 3 2002 <br /> If diffeuStM Y c <br /> #efiudejrmalron <br /> WWOFEMERGENCYSERWEt <br /> ADDITIONAL BUSINESS INFORMATION <br /> TYPE OF Fig <br /> Single Owner ❑Partnership UNSTAFFED SITE NETWORK(44) <br /> ORGANIZATION (43) Corporation El Public Agency ❑YES �NO <br /> ASSESSOR PARCEL NO. (45) O ( --; Z( © S 1 <br /> PROPERTY OWNER (46) PHONE NO.(47) <br /> NAME LAS C.At—ktr+1S Z�5 .3u£S.1ZS5 <br /> (If different from Business Owner) <br /> PROPERTY OWNER (48) <br /> ADDRESS <br /> Street Address <br /> AC.A�^A o 4SZ2� <br /> CITY STATE ZIP <br /> FIRE DISTRICT (49) <br /> vJ�'�9C5W Ol_r6- <br /> NEAREST CROSS (50) <br /> STREET Wuop(32 Dlxe- �n <br /> FACILITY (51) r-i IF YES, <br /> LOCK BOX OYES ®NO WHERE IS IT LOCATED?(52) <br /> NATURE OF BUSINESS (53) <br /> WASTE GENERATOR (54) YES, <br /> W <br /> YES ❑NO WHAT IS YOUR EPA NO.?(55) (_,p�c�c,o Z3�.-� l$( <br /> TRADE SECRET (56) D SPILL PREVENTION (57) <br /> INFORMATION ti`= AND COUNTERMEASURES <br /> PLAN FOR THIS MCMI <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 /> 12/01 <br />