Laserfiche WebLink
0 <br />r-] <br />UNIFIED PROGRAM CONSOLIDATED FORM <br />FACILITY INFORMATION <br />BUSINESS OWNER/OPERATOR IDENTIFICATION, PAGE 2 <br />LOCALLY COLLECTED INFORMATION <br />(03/22/2011 - 11:32:57 AM) <br />ORGANIZATION ❑ Single Owner ❑ Partnership <br />❑ Corporation ❑ Public Agency <br />ASSESSOR PARCEL NUMBER 140 <br />NEAREST CROSS STREET <br />141 <br />PROPERTY OWNER NAME (If different from Business Owner) 142 <br />PHONE NO. <br />143 <br />PROPERTY OWNER STREET ADDRESS 144 <br />PROPERTY OWNER CITY 145 <br />STATE 146 <br />ZIP CODE <br />147 <br />FIRE DISTRICT NAME 148 <br />FIRE DEPT NO. 149 <br />FACILITY LOCK BOX 150 <br />IF YES, WHERE IS IT LOCATED? <br />151 <br />NATURE OF BUSINESS <br />152 <br />WASTE GENERATOR 153 <br />1 IF YES, ENTER EPA NUMBER <br />154 <br />TRADE SECRET INFORMATION 155 <br />NO <br />SPILL PREVENTION AND COUNTERMEASURES PLAN PREPARED FOR FACILITY? <br />156 <br />TRAINING PROGRAM INFORMATION <br />Does your business have an employee training program that includes initial training and annual refreshers? <br />Does your business maintain written training records that show the training subject, date(s) of training, <br />names and signatures of employees trained, and names of instructor(s)? <br />157 <br />BILLING ADDRESS If different from Mailing Address, otherwise leave blank <br />BUSINESS BILLING ADDRESS <br />158 <br />BUSINESS BILLING CITY 159 <br />STATE 160 <br />ZIP CODE <br />161 <br />This area intentionally left blank <br />