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RECEIVED <br /> OCT 13 ?0 i 1 <br /> SAN JOAQUIN COUNTY <br /> OFFICE OF EMERGE SERVICES <br /> UNIFIED PROGRAM CONSOLIDATED FORM <br /> FACILITY INFORMATION <br /> BUSINESS OWNER/OPERATOR IDENTIFICATION,PAGE 2 <br /> LOCALLY COLLECTED INFORNIATION <br /> (10/14/2009-05:13:16 PM) <br /> TYPE OF 138 UNSTAFFED SITE NETWORK 139 <br /> ORGANIZATION ❑Single Owner ❑Partnership NO <br /> ®Corporation ❑Public Agency <br /> ASSESSOR PARCEL NUMBER 140 NEAREST CROSS STREET 141 <br /> 179.260.51 ARCH ROAD <br /> PROPERTY OWNER NAME(If different from Business Owner) 142 PHONE NO. 143 <br /> EAGE INVESTMENTS LLC 209-948.2438 <br /> PROPERTY OWNER STREET ADDRESS 144 PROPERTY OWNER CITY 145 STATE 146 ZIP CODE 147 <br /> 8657 RANCH DR. TRACY CA 95304 <br /> FIRE DISTRICT NAME 148 FIRE DEPT NO. 149 FACILITY LOCK BOX 1501F YES,WHERE IS IT LOCATED? 151 <br /> STOCKTON N/A NO <br /> NATURE OF BUSINESS 152 <br /> GAS STATION/RETAIL STORE <br /> WASTE GENERATOR 153 1 IF YES,ENTER EPA NUMBER 154 <br /> YES N/A <br /> TRADE SECRET INFORMATION 155 SPILL PREVENTION AND COUNTERMEASURES PLAN PREPARED FOR FACILITY? 156 <br /> NO NO <br /> TRAINING PROGRAM INFORMATION 157 <br /> Does your business have an employee training program that includes initial training and annual refreshers? YES <br /> Does your business maintain written training records that show the[mining subject,date(s)of training, YES <br /> names and signatures of employees trained,and names of instructor(s)? <br /> BILLING ADDRESS If different from Mailing Address,otherwise leave blank <br /> BUSINESS BILLING ADDRESS 158 <br /> BUSINESS BILLLING CITY 159 STATE 160 ZIP CODE 161 <br /> This area intentionally left blank <br />