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BUSINESS OWNER/OPERA'1 OR IDENTIFICATION PAGE <br />MAILING ADDRESS (41) <br />If different from Site Address, <br />otherwise leave blank <br />NOTE: All official mail <br />will go to this address <br />BUSINESS MAILING AND BILLING INFORMATION <br />301 F7 WASHINGTON <br />0.. • T.. <br />BILLING ADDRESS (42) <br />If different from Mailing <br />Address, otherwise leave blank <br />TYPE OF <br />ORGANIZATION (43) <br />DEC - <br />Page 2 <br />Street No. Direction Street Name =�e� <br />MODESTO CA 95354 <br />City State ZIP <br />Street No. Direction Street Name Street Type <br />City State ZIP <br />ASSESSOR PARCEL NO. (45) <br />ADDITIONAL BUSINESS INFORMATION <br />PSingle Owner ❑ Partnership UNSTAFFED SITE <br />Corporation ❑ Public Agency NETWORK (44) <br />PROPERTY OWNER (46) PHONE NO. (47) <br />NAME <br />(If different from Business Owner) <br />PROPERTY OWNER (48) <br />ADDRESS <br />FIRE DISTRICT NO. <br />NEAREST CROSS <br />STREET <br />FACILITY <br />LOCK BOX <br />(50) <br />Street Address <br />CITY STATE ZIP <br />FIRE DISTRICT (49) <br />NAME <br />(51) IF YES, <br />WHERE IS IT LOCATED? (52) <br />NATURE OF BUSINESS (53) (PREFAB STORAGE SHEDS <br />WASTE GENERATOR (54) D IF YES, <br />WHAT IS YOUR EPA NO.? (55) <br />TRADE SECRET (56)SPILL PREVENTION (57) <br />INFORMATION 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) <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)? <br />DATE REC'D: 12/4/03 <br />