Laserfiche WebLink
UNIFIED PROGRAM CONSOLIDATED FORM <br /> FACILITY INFORMATION <br /> BUSINESS OWNER/OPERATOR IDENTIFICATION,PAGE 2 <br /> LOCALLY COLLECTED INFORMATION <br /> (03/22/2011 - 11:31:18 AM) <br /> ORGANIZATION ❑Single Owner ❑Partnership <br /> ®Corporation ❑Public Agency NO <br /> ASSESSOR PARCEL NUMBER 140 NEAREST CROSS STREET 141 <br /> 062-510-04 KETTLEMAN <br /> PROPERTY OWNER NAME(If different from Business Owner) 142 PHONE NO, 143 <br /> BILL MAXWELL N/A <br /> PROPERTY OWNER STREET ADDRESS 144 PROPERTY OWNER CITY 145 STATE 146 ZIP CODE 147 <br /> 1129 W WALNUT STREET STOCKTON CA 95203 <br /> FIRE DISTRICT NAME 148 FIRE DEPT NO.149 FACILITY LOCK BOX 150 IF YES,WHERE IS IT LOCATED? 151 <br /> LODI 20 NO <br /> NATURE OF BUSINESS <br /> 152 <br /> AUTO REPAIR <br /> WASTE GENERATOR 153 IF YES,ENTER EPA NUMBER 154 <br /> YES CAL000343853 <br /> TRADE SECRET INFORMATION 155 SPILL PREVENTION AND COUNTERMEASURES PLAN PREPARED FOR FACILITY? 156 <br /> NO <br /> YES <br /> TRAINING PROGRAM INFORMATION 157 <br /> Does your business have an employee mining program that includes initial training and annual refreshers? YES <br /> Does your business maintain written training records that show the training 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 <br /> 158 <br /> BUSINESS BILLING CITY 159 STATE 160 ZIP CODE 161 <br /> This area intentionally left blank <br />