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. ........... <br /> UNIFIED PROGRAM CONSOLIDATED FORM <br /> FACTLITV INFORMATION <br /> BUSINESS OWNER/OPERATOR IDENTIFICATION, PAGE 2 <br /> LOCALLY COLLECTED INFORMATION <br /> TYPE OF Single Owner El corporation ❑El Partnership ITF.TWnRT< 139 <br /> nn�-n 1.7 A�rTnXT NO <br /> A'qFqO()R PARCH.NT JMRPR 1401 NEAREST CROSS STREET 141 <br /> 051-060-30 BRUELLA <br /> PROPERTY OWNER NAME(If different from Business Owner) 1421 PHONE NO. 143 <br /> BILL BRAUN 209-603-8979 <br /> PROPERTY OWNER STREET ADDRESS 1441pROPERTY OWNER CITY 145 STATE 1461ZIP CODE 147 <br /> 8832 E.HWY 12 VICTOR CA 95253 <br /> FIRE DISTRICT NAME 141FIRE DEPT NO. 14 FACILITY LOCK BOX 15011F YES,WHERE IS IT LOCATED? 151 <br /> MOKELUMNE Fl) 13 NO <br /> 34ATT TRR OF R1 TvTNFvR 152 <br /> WELDING REPAIR SHOP <br /> WASTE GENERATOR 153 1 IF YES.ENTER EPA NUMBER 154 <br /> YES 3241781 <br /> TR A DF qFC.R FT INFOR MA TTON 1551 SPILL PREVENTION AND COT TNTERMEASURES PLAN PREPARED FOR FACILITY? 156 <br /> NO YES <br /> TRAINING PROGRAM INFORMATION 157 <br /> NO <br /> Does your business maintain written training records that show the training subject,date(s)of training, NO <br /> RIT.I.MG A nnRF'Z,'Z Tf fliM ..t&..IVF.Hin. A,1,1, c-Mh.,wkhl.nk <br /> BUSINESS BILLING ADDRESS 158 <br /> P.O.BOX 726 <br /> BUSINESS BILLING CITY 1111 STATE 1111 ZIP CODE 161 <br /> VICTOR CA 95253 <br /> This area intentionally left blank <br />