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UNIFIED PROGRAM CONSOLIDATED FORM <br /> FACTT.TTV TNFORMATTON <br /> BUSINESS OWNER/OPERATOR IDENTIFICATION, PAGE 2 <br /> LOCALLY COLLECTED INFORMATION <br /> TYPE OF <br /> ❑ <br /> non_A TIT7 A TTnXT Single Owner ❑ Corporation ®Partnership 138 TTNRTAFFFD RTTF.NFTWORx 139 <br /> NO <br /> ASSFRRDR PARCFT.NTTMRFR 140 NEAREST CROSS STREET 141 <br /> 147-220-09 HAZELTON <br /> PROPERTY OWNER NAME(If different from Business Owner) 142 PHONE NO. 143 <br /> RICHARD MCCLURE 209-466-9617 <br /> PROPERTY OWNER STREET ADDRESS 144 PROPERTY OWNER CITY 145 STATE 146 ZIP CODE 147 <br /> 735 S SUTTER STOCKTON CA 95203 <br /> FIRE DISTRICT NAME 148 FIRE DEPT NO. 149 FACILITY LOCK BOX 150 IF YES,WHERE IS IT LOCATED? 151 <br /> STOCKTON 22 NO <br /> NATURF.OF RTTRINRSS 152 <br /> WOODWORKING <br /> WASTE GENERATOR 153 IF YES.ENTER EPA NUMBER 154 <br /> NO NA <br /> TR ADR.RFC.RFT TNFDRMATIDN 155 SPILL PREVENTION AND COTTNTF.RMEASURES PLAN PREPARED FOR FACILITY? 156 <br /> NO YES <br /> TRAINING PROGRAM INFORMATION 157 <br /> ........: :_ _ L-.:_-]..A- : :.: I _:_: --A ._.....J_ 0. L 0 YES <br /> Does your business maintain written training records that show the training subject,date(s)of training, YES <br /> RILLING AnDRF.SC If different from Mailino AW ..nth.r.kc Iravr hN.k <br /> BUSINESS BILLING ADDRESS 158 <br /> BUSINESS BILLING CITY 159 STATE 160 ZIP CODE 161 <br /> This area intentionally left blank <br />