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''��,� rCa z ,g ZUU4 <br /> BUSINESS OWNER/OPER <br /> A'I'OR IDENTIFICATION PAGE Page 2 <br /> BUSINESS MAILING AND BILLING INFORMATION <br /> MAILING ADDRESS(41) PO BOX 2637 <br /> If different from Site Address, <br /> otherwise leave blank Street No. Direction Street Name Street Type <br /> NOTE: All official mail FRESNO CA 93745 <br /> will go to this address <br /> City State ZII' <br /> BILLING ADDRESS(42) <br /> If different from Mailing <br /> Address,otherwise leave blank Street No. Direction Street Name Street Type <br /> City State ZIP <br /> ADDITIONAL BUSINESS INFORMATION <br /> TYPE OF ❑Single Owner ❑Partnership UNSTAFFED SITE NO <br /> ORGANIZATION(43) N Corporation ❑Public Agency NETWORK(44) <br /> ASSESSOR PARCEL NO. (45) <br /> APN 143220-14 <br /> PROPERTY OWNER (46) PHONE NO. (47) <br /> NAME WILLEY CHANDLER 209-933-4372 <br /> (If different from Business Owner) <br /> PROPERTY OWNER (48) <br /> ADDRESS 3127 E FREMONT <br /> Street Address <br /> STOCKTON CA 95205 <br /> CITY STATE ZIP <br /> FIRE DISTRICT NO. 22 FIRE DISTRICT (49) <br /> NAME STOCKTON <br /> NEAREST CROSS (50) BROADWAY <br /> STREET <br /> FACILITY (51) NO IF YES, N/A <br /> LOCK BOX WHERE IS IT LOCATED?(52) <br /> NATURE OF BUSINESS (53) FORKLIFT SALES, RENTAL & SVC <br /> WASTE GENERATOR (54) IF YES, <br /> WHAT IS YOUR EPA NO.?(55) CAD982371122 <br /> TRADE SECRET (56) SPILL PREVENTION (57) <br /> INFORMATION NO AND COUNTERMEASURES YES <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 <br /> Does your business maintain written training records that show the training subject,date(s)of training, (59) YES <br /> names and signatures of employees trained,and names of instructor(s)? <br /> DATE REC'D: 2/27/04 <br />