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Akk Aft <br /> BUSINESS OWNER/OPERATOR IDENTIFICATION FOR SIDE 2 <br /> BUSINESS MAILING AND BILLING INFORMATION <br /> MAILING ADDRESS re �D [/ ® <br /> (If different from Site Address) Q <br /> NOTT,All time sensitive and Street No. Direction Street Name Street Type <br /> official correspondence will (� �`����S <br /> be sent qldges <br /> J A 2001 <br /> CI'T'Y STATE ZIP <br /> B _RESS. 42 <br /> If t ICE <br /> include"Care ofinformaton <br /> SEP 25 2001 <br /> IFRCEOFEMERGENCYSERVICES AP-FYIONAL BUSINESS INFORMATION <br /> TYPE OF Single Owner ❑Partnership UNSTAFFED SITE NETWORK(44) �yES O <br /> ORGANIZATION (431 ❑Corporation r ❑Public Agency <br /> ASSESSOR PARCEL NO. (45) <br /> PROPERTY OWNER (46) — / PHONE NO.(47) <br /> NAME <br /> (If different from Business Owner) YY <br /> PROPERTY OWNER (48) 9 la <br /> ADDRESS Q�/ �� , //L/ <br /> Street ss <br /> CITY STATE ZIP <br /> FIRE DISTRICT (49) <br /> NEAREST CROSS (50) <br /> STREET I 1016( OSA/ <br /> FACILITY (51) IF YES, <br /> LOCK BOX ❑YES NO WHERE IS IT LOCATED?(52) <br /> NATURE OF BUSINESS (53) <br /> WASTE GENERATOR (54) IFYES, <br /> ES [:]NO 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) lys [:]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 /> 12100 <br />