Laserfiche WebLink
BUSINESS OWNER/OPERATOR IDENTIFICATION FORM SIDE 2 <br /> BUSINESS MAILING AND BILLING INFORMA'T'ION <br /> MAILING ADDRESS L <br /> (II'different from Site Address) <br /> NOTE: All time sensitive and Street No. Direction Street Name Street Type (I <br /> be cialsent tothis address will I <br /> be sent to this address <br /> CITY STATE ZIP <br /> BILLING ADDRESS(42) <br /> If different from above, <br /> include"Care of information <br /> ADDITIONAL BUSINESS INFORMATION <br /> TYPE OFSingle Owner ❑ Partnership UNSTAFFED SITE NETWORK(44) ❑�,ES ❑NO <br /> ORGANIZATION (43) M Corporation ❑ Public Agency <br /> ASSESSOR PARCEL NO. (45) <br /> 179-100-11-0 <br /> PROPERTY OWNER (46) PHONE NO. (47) <br /> NAME GORHAM FAMILY PARTNERSHIP ( 209)466-0988 <br /> (If different from Business.Owner) <br /> PROPERTY OWNER (48) <br /> ADDRESS F3033 S . HWY 99 <br /> Street Address - <br /> STOC T 95915. : <br /> CITY STA'1•E ZIP <br /> FIRE DISTRICT (49) <br /> MONTEZUMA <br /> NEAREST CROSS (50) <br /> STREET MARIPOSA ROAD <br /> FACILITY (51) 1F YES,'; <br /> YES NO WHERE IS IT LOCATED? 52 <br /> LOCKBOX ❑ ® ( )1 ;:� <br /> NATURE OF BUSINESS, (53) <br /> STEEL PIPE DISTRIBUTOR <br /> WASTE GENERATOR (54) IF YES, <br /> ❑YES ©NO WHAT IS YOUR EPA NO.?(55) <br /> TRADE SECRET (56) SPILL PREVENTION (57) <br /> INFORMATION AND COUNTERMEASURES NO <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 NO <br /> 12/00 <br />