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S R/OPERA``1R IDENTIFICATION FORM SIDE 2 <br /> BUSINESS MAILING AND BILLING INFORMATION <br /> MAILI1QCi�DbRtES$'(Al) �� �� <br /> (I pflixtuBiWU�ttld1'ess <br /> �I �isYit� �1 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 ❑Single Owner INPartnership UNSTAFFED SITE NETWORK(44) <br /> ORGANIZATION (43) ❑Corporation ❑Public Agency ❑YES �NO <br /> ASSESSOR PARCEL NO. (45) <br /> NAME <br /> PROPERTY OWNER (46) PHONE NO. (47) <br /> (If different from Business Owner) <br /> PROPERTY OWNER (48) <br /> ADDRESS / <br /> l D Street Address <br /> CITY STATE ZIP <br /> FIRE DISTRICT (49) <br /> NEAREST CROSS (50) <br /> STREET <br /> FACILITY (51) IF YES, <br /> LOCK BOX ❑YES �NO WHERE IS IT LOCATED?(52) <br /> NATURE OF BUSINESS (53) <br /> WASTE GENERATOR (54) IF YES, <br /> ❑YES �NO WHAT IS YOUR EPA NO.?(55) <br /> TRADE SECRET (56) !�SPILL PREVENTION (57) <br /> INFORMATION ��/ AND COUNTERMEASURES S <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) YES ❑NO <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)? YES ❑NO <br /> 12/03 <br />