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rORGANIZXTION <br /> UNIFIED PROGRAM CONSOLIDATED FORM <br /> FACILITY INFORMATION <br /> BUSINESS OWNER/OPERATOR IDENTIFICATION,PAGE 2 <br /> LOCALLY COLLECTED INFORMATION <br /> (01/22/2009- 08:46:31 AM) <br /> OF ❑SingleOwncr ❑Partnership 138 UNSTAFFED SITE NETWORK 139®Corporation ❑Public Agency NOSSOR PARCEL NUMBER 140 NFAREST CROSS STREET 141 <br /> 179-110-08 MARAPOSA <br /> PROPERTY OWNER NAME(If different from Business Owner) 142 1 PHONE NO. 143 <br /> ROBERT HILL 408 297-7906 <br /> PROPERTY OWNER STREET ADDRESS 144 PROPERTY OWNER CITY 145 STATE 146 ZIP CODE 147 <br /> 348 PHELAN AVE SAN JOSE CA 95112 <br /> FIRE DISTRICT NAME 148 FIRE DEPT NO. 149 FACILITY LOCK BOX 150 IF YES,WHERE IS IT LOCATED? 151 <br /> MONTEZUMA N/A NO N/A <br /> NATURE OF BUSINESS 152 <br /> STORAGE FACILITY <br /> WASTE GENERATOR 153 1 IF YES,ENTER EPA NUMBER 154 <br /> NO N/A <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 ant 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 />