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UNIFIED PROGRAM CONSOLIDATED FORM <br /> FACILITY INFORMATION <br /> BUSIN SS OWNERIOPERATOR IDENTIFICATION, PAGE 2 <br /> LOCALLY COLLECTED INFORMATION <br /> (10/14/2009-01:36:12 PM) <br /> TYPE OF138 UNSTAFFED SITE NETWORK 139 <br /> ORGANIZATION ®Single wner ❑Partnership <br /> ❑Corporation ❑Public Agency NO <br /> ASSESSOR PARCEL NUMBER 140 NEAREST CROSS STREET 141 <br /> 139-040-12 ACACIA <br /> PROPERTY OWNER NAME(If diff rent from Business Owner) 142 PHONE NO. 143 <br /> LARRY HESTER 408-866-5840 <br /> PROPERTY OWNER STREET AD ESS144 PROPERTY OWNER CITY 145 STATE 146 ZIP CODE 147 <br /> 400 INDUSTRIAL ST CAMPBELL CA 95008 <br /> FIRE DISTRICT NAME 148 FIRE DEPT NO.149 FACILITY LOCK BOX 150 IF YES,WHERE IS IT LOCATED? 151 <br /> STOCKTON 602A NO <br /> NATURE OF BUSINESS 152 <br /> AUTO REPAIR <br /> WASTE GENERATOR 153 1 IF YES,ENTER EPA NUMBER 154 <br /> YES CAL000089332 <br /> TRADE SECRET INFORMATION 155 SPILL PREVENTION AND COUNTERMEASURES PLAN PREPARED FOR FACILITY? 156 <br /> NO NO <br /> TRAINING PROGRAM INFORMATION 157 <br /> Does your business have an employee training program that includes initial training and annual refreshers? YES <br /> Does your business maintain written t aining records that show the training subject,date(s)of training, YES <br /> names and signatures of employees trained,and names of instructor(s)? <br /> ILLING ADDRESS If different from Mailing Address,otherwise leave blank <br /> BUSINESS BILLING ADDRESS 158 <br /> BUSINESS BILLLING CITY 159 STATE 160 ZIP CODE 161 <br /> This area intentionally left blank <br />