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UNIFIED PROGRAM CONSOLIDATED FORM <br /> FACILITY INFORMATION <br /> BUSINESS OWNER/OPERATOR IDENTIFICATION,PAGE 2 <br /> LOCALLY COLLECTED INFORMATION <br /> (05/07/2009- 10:40:23 AM) <br /> TYPE OF 138 UNSTAFFED SITE NETWORK 139 <br /> ORGANIZATION ❑Single Owner [I Partnership <br /> ®Corporation ❑Public Agency NO <br /> ASSESSOR PARCEL NUMBER 140 NEAREST CROSS STREET 141 <br /> 110-020-03 MARCH LN <br /> PROPERTY OWNER NAME(If different from Business Owner) 142 1 PHONE NO. 143 <br /> 7-ELEVEN INC ATTN ENVIRONMENTAL DEPT. 800-828-0711 <br /> PROPERTY OWNER STREET ADDRESS144 PROPERTY OWNER CITY 145 STATE 146 ZIP CODE 147 <br /> P.O BOX 711JDALLAS TX 17.5221-0711 <br /> FIRE DISTRICT NAME 148 FIRE DEPT NO,149 FACILITY LOCK BOX 150 IF YES,WHERE IS IT LOCATED? 151 <br /> STOCKTON FD 41 NO <br /> NATURE OF BUSINESS 152 <br /> RETAIL PETROLEUM/FOOD STORE <br /> WASTE GENERATOR 153 IF YES,ENTER EPA NUMBER 154 <br /> YES CAD981466594 <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 training records that show the training subject,date(s)of training, YES <br /> names and signatures of employees trained,and names of instructor(s)? <br /> BILLING ADDRESS If different from Mailing Address,otherwise leave blank <br /> BUSINESS BILLING ADDRESS 158 <br /> P.O.BOX 711-GASOLINE ACCTG <br /> BUSINESS BILLING CITY 159 STATE, 160 ZIP CODE 161 <br /> DALLAS' TX 75221-0711 <br /> This area intentionally left blank <br /> - I <br /> I <br /> i <br /> i <br /> I <br />