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BUSINESS OWNER/OPERATOR IDENTIFICATION FORM SIDE 2 <br /> USINESS MAILING AND BILLING INFORMATION <br /> MAILING ADDRESS(41 <br /> (If different from Site Address 0 <br /> NOTE: All time sensitive and Street No. Direction Street Name <br /> official correspondence will <br /> be sent to this address Q f }C 7S O <br /> CITY STATE ZIP <br /> SAV Wunly <br /> BILLING ADDRESS(42)) /ff¢N: r; on� rm.'s OFRCEOFEMERGENCYSERIC S <br /> If different from above, 6 O <br /> include"Care of information <br /> Do//ur, Tx 7S 2�f1� <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 /> PROPERTY OWNER (46) PHONE NO. (47) <br /> NAME <br /> (If different from Business Owner) <br /> PROPERTY OWNER (48) <br /> ADDRESS <br /> Street Address <br /> CITY STATE ZIP <br /> FIRE DISTRICT (49) <br /> Gt .4 5 .,cktan <br /> NEAREST CROSS (50) <br /> STREET OL-)- yh 00 <br /> FACILITY (51) IF YES, <br /> LOCK BOX ❑YES �NO WHERE IS IT LOCATED?(52) <br /> NATURE OF BUSINESS (53) An <br /> ra vI <br /> WASTE GENERATOR (54) EE� IF YES, <br /> WHAT IS YOUR EPA NO.?(55) <br /> TRADE SECRET SPILL <br /> IN O MA'ION (56) �� ANDPLACOR TER PACILI ES 57)Ci= <br /> TRAINING PROGRAM INFORMATION <br /> Does your business have an employee training program that includes initial training and annual refreshers? (58) ayES ❑NO <br /> Does your business maintain written training records that show the training subject,date(s)of training, (59)r� <br /> names and signatures of employees trained,and names of instructor(s)? I YES ❑NO <br /> 12100 <br />