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BUSINESS OWNER/OPERATOR IDENTIFICATION PAGE Page 2 <br /> BUSINESS MAILING AND BILLING INFORMATION <br /> MAILING ADDRESS(41) 3 e-��Ez OoVA-rJ L <br /> If different from Site Address, ^ <br /> otherwise leave blank Street No. Direction Street Name Strect Type <br /> NOTE:All official mail will <br /> go to this address t i�Mo N i A a <br /> CITY STATE ZIP <br /> BILLING ADDRESS(42) woo M�R`I�bt4AF� S�} //1 FT h—a v 4 <br /> If different from Mailing <br /> Address,otherwise leave blank Street No. Direction Street Name Stree,.Type <br /> City State 'LIP <br /> AD!!ITNAL BUSINESS INFORMATION <br /> TYPE OF Ingle Owner ❑Partnership UNSTAFFED SITE NO <br /> ORGANIZATION(43) 114 Cocpemwitm ❑Public Agency NETWORK(44) <br /> ASSESSOR PARCEL NO. (45) <br /> 1092-110-09 <br /> PROPERTY OWNER (46) HONE NO.(47) <br /> NAME <br /> (If different from Business Owner) <br /> PROPERTY OWNER (48) r 1 C <br /> ADDRESS �" ..VE 3 S 1 C.0 AJO VA—/v L_-q- <br /> /� <br /> Street Address <br /> J( —E� — SFJ— <br /> City State ZIP <br /> FIRE DISTRICT NO. 15 FA1?¢DISTRICT (49)IWATERLOO-MORADA <br /> NEAREST CROSS (50) <br /> STREET HAMMER LANE <br /> FACILITY (51) NO IF YES, N/A <br /> LOCK BOX I I WHERE IS IT LOCATED?(52) <br /> NATURE OF BUSINESS (53) <br /> GAS sTA'r1oN <br /> WASTE GENERATOR (54) NO IF YES, <br /> WHAT IS YOUR EPA NO.?(55) CAD981459738 <br /> TRADE SECRET (56) SPILL PREVENTION (57) <br /> INFORMATION NO AND COUNTERMEASURES NO <br /> PLAN FOR THIS FACILITY <br /> TRAIMNG 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) YE$ <br /> names and signatures of employees trained,and names of instructor(s)? — <br />