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BUSINESS OWNER/OPERATOR IDENTIFICATION PAGE %./ Page 2 <br /> BUSINESS MAILING AND BILLING INFORMATION <br /> "MAILING ADDRESS(41) <br /> 11 <br /> If different from Site Address, <br /> otherwise leave blank Street No. Direction Street Name Street Type <br /> NOTE: All official mail <br /> will go to this address <br /> City State ZIP <br /> BILLING ADDRESS(42) <br /> If different from Mailing <br /> Address,otherwise leave blank tree[No. Direction Street Name Street Type <br /> City State ZIP <br /> ADDITIONAL BUSINESS INFORMATION <br /> TYPE OF ®Single Owner ❑Partnership UNSTAFFED SITE <br /> ORGANIZATION (43) ❑Corporation ❑Public Agency NETWORK(44) INO <br /> ASSESSOR PARCEL NO.(45) <br /> 09-310-05 <br /> PROPERTY OWNER (46) PHONE NO.(47) <br /> NAME UINCY CARGILE 12098236584 <br /> (If different from Business Owner <br /> PROPERTY OWNER (48) <br /> ADDRESS 178 BUTTON AVE <br /> Street Address <br /> ANTECA 5336 <br /> CITY STATE ZIP <br /> FIRE DISTRICT NO. FIRE DISTRICT (49) <br /> 4 NAME IMANTECA CITY <br /> NEAREST CROSS (50) <br /> STREET FYOSEMITE AVE <br /> FACILITY (51) IF YES, /A <br /> LOCK BOX WHERE IS IT LOCATED?(52) <br /> NATURE OF BUSINESS (53) <br /> UTO REPAIR <br /> WASTE GENERATOR (54) ES IF YES, <br /> WHAT IS YOUR EPA NO:?(55) 1CAL000294252 <br /> TRADE SECRET (56) SPILL PREVENTION (57) <br /> INFORMATION NO AND COUNTERMEASURES NO <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) O <br /> Does your business maintain written training records that show the training subject,date(s)of training, (59) <br /> names and signatures of employees trained,and names of instructor(s)? O <br /> DATE REC'D: 5/M08 <br />