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UNIFIED PROGRAM CONSOLIDATED FORM <br /> FACTLITV INFORMATT(IN <br /> BUSINESS OWNER/OPERATOR IDENTIFICATION, PAGE 2 <br /> LOCALLY COLLECTED INFORMATION <br /> TYPE OF Single Owner El Corporation El Partnership 1381T 1111.'ITAFFVll 11ITTI,NFTW11RT< 139 <br /> JD 0-A XTT7 A� X� NO <br /> ARRF.qROR PARr.FT.11JI TMRFR 1401 NEAREST CROSS STREET 141 <br /> 08710046 WATERLOO RD <br /> PROPERTY OWNER NAME(If different from Business Owner) 1421 PHONE NO. 143 <br /> C.0 ZACHARIAH 209-836-1489 <br /> PROPERTY OWNER STREET ADDRESS 144�PROPERTY OWNER CITY 145 STATE 1461ZIP CODE 147 <br /> 7777 BATES ROAD TRACY CA, 95376 <br /> FIRE DISTRICT NAME 148 FIRE DEPT NO. 14 FACILITY LOCK BOX 151 IF YES,WHERE IS IT LOCATED? 151 <br /> WATERLOO-MORADA 15 NO <br /> VATT TRF OF RtTqTNF.'.q 152 <br /> AUTO REPAIR,AUTO PARTS <br /> WASTE GENERATOR 1531 IF YES.ENTER EPA NUMBER 154 <br /> YES CAL000315725 <br /> TRAnF qFrRFT WFORMATMN 1551 SPILL PREVENTIONAND COI JNTERMEASURES PLAN PREPARED FOR FACILITY? 156 <br /> NO NO <br /> TRAINING PROGRAM INFORMATION 157 <br /> A :-:9-1 A YES <br /> Does your business maintain written training records that show the training subject,date(s)of training, YES <br /> --A -:--, --A <br /> RTT.T,TN(' A nnRV.qqTfdiMrP.t&.-M.M..Addrec . <br /> BUSINESS BILLING ADDRESS 158 <br /> BUSINESS BILLING CITY 1591 STATE 1601 ZIP CODE 161 <br /> This area intentionally left blank <br />