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'l9WNER/OPERATOR IDENTIFICATION FORM SIDE 2 <br /> uiU I BUSINESS MAILING AND BILLING INFORMATION <br /> M A I�(p({@{ICA�I6ES�,641) <br /> E Street Name Street Type <br /> NOTE: All time sensitive and Street No. Direction <br /> official correspondence will <br /> be sent to this address CITY STATE ZIP <br /> BILLING ADDRESS(42) STOCKTON CA 953205 <br /> If different from above, P .O. BOX 5503 <br /> include"Care of information <br /> ADDITIONAL BUSINESS INFORMATION <br /> TYPE OF ❑Single Owner ❑Partnership UNSTAFFED SITE NETWORK(44) ❑yES ©NO <br /> ORGANIZATION (43) ®Corporation ❑Public Agency <br /> ASSESSOR PARCEL NO. (45) <br /> r179-160-03 <br /> PHONE NO.(47) <br /> PROPERTY OWNER (46) ( 209)464-83,14 <br /> NAME R & R INVESTMENTS <br /> (If different from Business Owner) <br /> PROPERTY OWNER (48) <br /> ADDRESS O, B X 30 <br /> Street Address <br /> q991 3 <br /> STOCK STATE ZIP <br /> CITY <br /> FIRE DISTRICT l49) <br /> MONTEZUMA FIRE DISTRICT <br /> NEAREST CROSS (50) <br /> STREET MARIPOSA ROAD <br /> FACILITY (51) �� YES, <br /> LOCK BOX ❑YES QX NO W WHERE IS IT LOCATED?(52) <br /> NATURE OF BUSINESS (53) <br /> TRUCKING—GENERAL COMMO( TTIES <br /> WASTE GENERATOR (54) IF YES, �� <br /> YES ��NO WHAT IS YOUR F.PA NO.?(55) 00 <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) • yES ❑NO <br /> Does your business maintain written training records that show the training subject,date(s)of training, (59) []YES []NO <br /> names and signatures of employees trained,and names of instructor(s)? 12f00 <br />