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B.IJS[NLSS ,OWNER/OPEF 'OR IDENTIFICATION PAGE SIDE. 2 <br /> _ BUSINESS MAILING AND BILLING INFORMATION <br /> MAILING ADDRESS(4I) <br /> (If different from Site Address) <br /> NOTE: All time sensitive and Street No. Direction Street Name Street Type <br /> official correspondence will <br /> be sent to this address <br /> CITY STATE ZIP <br /> BILLING ADDRESS(42) <br /> If different from above, <br /> include"Care of information <br /> ADDITIONAL BUSINESS INFORMATION <br /> TYPE OF ❑ ingle Owner ❑Partnership UNSTAFFED SITE NETWORK(44) YES NO <br /> ORGANIZATION (43) gCorporation ❑ Public Agency <br /> ASSESSOR PARCEL NO. (45) <br /> PROPERTY OWNER (46) � „ (�� 1 ro PHONE NO.(47) <br /> NAME <br /> (If different from Business Owner) <br /> PROPERTY OWNER (48) C"� <br /> �c j/����� ( � <br /> ADDRESS ` `-�� <br /> Street Address n, <br /> L <br /> CS ATE ZI <br /> FIRE DISTRICT (49) <br /> �l?AIzCZ <br /> NEAREST CROSS (50) <br /> STREET <br /> r <br /> FACILITY (51) t—IYES LN IF YES, <br /> LOCK BOX LJ WHERE IS IT LOCATED?(52) <br /> NATURE OF BUSINESS (53) <br /> WASTE GENERATOR (54) IF YES, <br /> WYES ❑NO WHAT IS YOUR EPA NO.?(55) <br /> TRAINING PROGRAM INFORMATION <br /> Does your business have an employee training program that includes initial training and annual refreshers? (56) yES NO <br /> Does your business maintain written training records that show the training subject,date(s)of training, (57) YES F]NO <br /> names and signatures of employees trained, and names of instructor(s)? <br /> SJC 12/99 <br />