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BUSINESS OWNER/OPERATOR IDENTIFICATION PAGE Page 2 <br /> BUSINESS MAILING AND BILLING INFORMATION <br /> MAILING ADDRESS �� P.O.BOX 6219 <br /> If different from Site Address, <br /> otherwise leave blank Street No. Direction Street Name Street Type <br /> NOTE:All official mail will <br /> go to this address STOCKTON CA 95206 <br /> CITY STATE ZIP <br /> BILLING ADDRESS(42) <br /> Ifm �= <br /> different froMailing <br /> Address,otherwise leave blank Street No. Direction Street Name Street Type <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) 163-020-11 <br /> PROPERTY OWNER (46) 1 PHONE NO.(47) <br /> <br /> (If different from Business Owner) <br /> PROPERTY OWNER (48) <br /> ADDRESS P.O.BOX 58 <br /> Street Address <br /> HOLT CA 95234 <br /> City State ZIP <br /> FIRE DISTRICT NO. 707 FIRE DISTRICT (49) <br /> A NAME STOCKTON <br /> NEAREST CROSS (50) <br /> STREETTILLIE LEWIS <br /> FACILITY (51) NO IF YES, <br /> LOCK BOX WHERE IS IT LOCATED?(52) <br /> NATURE OF BUSINESS (53) RETAIL& SERVICE OF AG EQUIP <br /> WASTE GENERATOR (54) YES IF YES, <br /> WHAT IS YOUR EPA NO.?(55) CAL000223294 <br /> TRADE SECRET (56) SPILL PREVENTION (57) <br /> NO <br /> INFORMATION AND COUNTERMEASURES 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) <br /> Does your business maintain written training records that show the training subject,date(s)of training, (59) YES <br /> names and signatures of employees trained,and names of instrucmr(s)? <br />