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OCT - 2r 03 <br /> BUSINESS OWNER/OPEkm�R IDENTIFICATION PAGE Page 2 <br /> BUSINESS MAILING AND BILLING INFORMATION <br /> MAILING ADDRESS (41) �L <br /> If different from Site Address, I,} <br /> IF <br /> otherwise leave blank Street No. Direction Street Name y Street Type <br /> NOTE: All official mail <br /> will go to this address 'deli <br /> City State ;, ZIP <br /> BILLING ADDRESS(42) � I: <br /> If different from Mailing j <br /> Address,otherwise leave blank Street No. Direction Street Name Street Type <br /> City State ":ZIP <br /> ADDITIONAL BUSINESS INFORMATION 1' <br /> TYPE OF ❑Single Owner ❑Partnership UNSTAFFED SITE NO <br /> ORGANIZATION(43) ® Corporation ❑Public Agency NETWORK(44) <br /> •i, <br /> ASSESSOR PARCEL NO. (45) <br /> 143-280-29 <br /> PROPERTY OWNER (46) PHONE NO. (47) <br /> NAME TOM MAYO 209-943-6248 <br /> (If different from Business Owner) i <br /> PROPERTY OWNER (48) <br /> ADDRESS 4735 E. FREMONT ST. <br /> Street Address <br /> STOCKTON CA 9521.5 <br /> CITY STATE a',"ZIP <br /> FIRE DISTRICT NO, 612 FIRE DISTRICT (49) <br /> NAME CITY OF STOCKTON <br /> NEAREST CROSS (50) <br /> STREET N. ELLEN ST. <br /> FACILITY (51) NO IF YES, NSA I <br /> LOCKBOX I WHERE IS IT LOCATED?(52) <br /> NATURE OF.BUSINESS (53) GENERAL ENGINEERING <br /> WASTE GENERATOR (54) NG IF YES, N/A WHAT IS YOUR EPA NO.. (55) <br /> TRADE SECRET (56) SPILL PREVENTION (57) <br /> INFORMATION NO ::1 AND COUNTERMEASURES NO <br /> PLAN FOR THIS FACILITY "1 <br /> TRAINING PROGRAM INFORMATION Irl <br /> 1I <br /> Does your business have an employee training program that includes initial training and annual refreshers;,?,,(58) NO <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)? I <br /> DATE REC'D. 10/2103 <br />