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BUSINESS OWNER/OPrRATOR IDENTIFICATION FORM SIDE 2 <br /> BUSINESS MAILING AND BILLING INFORMATION <br /> MAILING ADDRESS(41) / <br /> (If different from Site Address) © 6 <br /> NOTE: All time sensitive and Street No. Direction Street Name Street Type <br /> official correspondence will <br /> be sent to this address <br /> CITY STATE �Fl <br /> BILLING ADDRESS(42) <br /> If different from above, MAR 21 2001 <br /> include"Care of information <br /> SANJUAUUINCOU <br /> OFFIMOFEMEHGENCYS VICES <br /> DITIONAL BUSINESS INFORMATION <br /> TYPE OF Wingle Owner ❑Partnership UNSTAFFED SITE NETWORK(44) YESNO <br /> ORGANIZATION (43) Corporation ❑Public Agency <br /> ASSESSOR PARCEL NO. (45) <br /> PROPERTY OWNER (46) PHONE NO. (47) <br /> NAME <br /> (If different from Business Owner) <br /> PROPERTY OWNER (48) <br /> ADDRESS <br /> Street Address <br /> CITY STATE <br /> FIRE DISTRICT ", <br /> NEAREST CROSS (50) <br /> STREET <br /> FACILITY (51) 1F YES, <br /> LOCK BOX ❑YES O WHERE IS IT LOCATED?(52) <br /> NATURE OF BUSINESS (53) <br /> WASTE GENERATOR (54) ® IF YES, <br /> ❑YES O WHAT IS YOUR EPA NO.?(55) <br /> TRADE SECRET (56) �l� SPILL PREVENTION (57) <br /> INFORMATION /` Ki 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 �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 O <br /> 12/00 <br />