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BUSINESS OWNER/OPERATOR IDENTIFICATION PAGE SIDE 2 <br /> BUSINESS MAILING AND BILLING INFORMATION <br /> MAILING ADDRESS ��F <br /> If different from Site Adddrere ss <br /> Street No. Direction Suect Name R Street Type <br /> � <br /> BILLING ADDRESS(42) CI'T'Y STATE )I <br /> If different from above; DEC 2 41998 U <br /> include"Care or,information <br /> SAN jGAQUi7J COUNT <br /> Y <br /> OFFICE CF EM,ERGE,gCY SERVICES <br /> ADDITIONAL BUSINESS INFORMATION <br /> TYPE OF UNMANNED SITE NETWORK44 <br /> ORGANIZATION(43) ( ) ❑YES X�NO <br /> Corporation <br /> BUSINESS LICENSE NO. (45) EXPIRATION DATE(46) <br /> 8125 12/31/99 <br /> ASSESSOR PARCEL NO. (47) <br /> 179-100-11-0 <br /> PROPERTY OWNER (48) PHONE NO. (49) <br /> NAME FFran7lGorham �yass) 69g-3sfb <br /> (If different from Business Owner) <br /> PROPERTY OWNER (50) <br /> ADDRESS 721 Via Palo Alto <br /> Street Address <br /> A tos CA 1 95003 <br /> FIRE DISTRICT (51) CITY STATE ZIP <br /> Montezuma <br /> NEAREST CROSS (52) <br /> STREET Mariposa Road <br /> FACILITY (53) ® IF YES, <br /> LOCK BOX <br /> YES NO WHERE IS IT LOCATED?(54) <br /> NATURE OF BUSINESS (55) <br /> Steel Pipe Distributor <br /> WASTE GENERATOR (56) IF YES, <br /> YES �NO WHAT IS YOUR EPA NO.?(57) <br /> TRAINING PROGRAM INFORMATION <br /> Does your business have an employee training program that includes initial training and annual refreshers? (58) ®YES NO <br /> Docs your business maintain written training records that show the training subject,dale(s)of training, (59) <br /> names and signatures of employees trained,and names of instructor(s)? YES NO <br /> SIC 12/96 <br />