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BUSINESS OWNER/OPERATOR IDENTIFICATION PAGE Page 2 <br /> BUSINESS MAILING AND BILLING INFORMATION <br /> MAILING ADDRESS d �= P.O. BOX 726 <br /> If different from Site Address, <br /> otherwise leave blank Street No. Direction Street Name Street Type <br /> NOTE: All official mail VICTOR CA 95253 <br /> will go to this address <br /> City State ZIP <br /> BILLING ADDRESS(42) �= P.O.BOX 726 <br /> If different from Mailing <br /> Address,otherwise leave blank Street No. Direction Street Name Street Type <br /> VICTOR CA 95253 <br /> City State ZIP <br /> ADDITIONAL BUSINESS INFORMATION <br /> TYPE OF ®Single Owner ❑Partnership UNSTAFFED SITE NO <br /> ORGANIZATION(43) ❑Corporation ❑Public Agency NETWORK(44) <br /> ASSESSOR PARCEL NO. (45) 051-060-30 <br /> PROPERTY OWNER (46) PHONE NO. (47) <br /> NAME BILL BRAUN 209-365-9416 <br /> (If different from Business Owner) <br /> PROPERTY OWNER (48) <br /> ADDRESS 16849 TRETHEWAY RD <br /> Street Address <br /> LODI CA 95253 <br /> CITY STATE ZIP <br /> FIRE DISTRICT NO. 13 FIRE DISTRICT (49) <br /> NAME IMOKELUMNE FD <br /> NEAREST CROSS (50) FiWLLA <br /> STREET <br /> FACILITY (51) NO IF YES, <br /> LOCK BOX WHERE IS IT LOCATED?(52) <br /> NATURE OF BUSINESS (53) WELDING REPAIR SHOP <br /> WASTE GENERATOR (54) S IF YES, 3241781 <br /> WHAT IS YOUR EPA NO.?(55) <br /> TRADE SECRET (56) D SPILL PREVENT57) <br /> AND COUNTERMEINFORMATION NO ASURES <br /> YES <br /> PLAN FOR THIS FACILITY <br /> TRAINING PROGRAM INFORMATION <br /> Does your business have an employee training program that includes initial training and annual refreshers? (58) NO <br /> Does your business maintain written training records that show the training subject,date(s)of training, (59) NO <br /> names and signatures of employees trained,and names of instructor(s)? <br /> DATE REC'D: 8/27/06 <br />