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ARk <br /> BUSINESS OWNER/OPERA OR IDENTIFICATION PAGE Page 2 <br /> BUSINESS MAILING AND BILLING INFORMATION <br /> MAILING ADDRESS ��� P.O.BOX 690514 <br /> If different from Site Address, <br /> otherwise leave blank Street No. Direction Street Name Street Type <br /> NOTE: All official mail STOCKTON CA <br /> will go to this address <br /> City State ZIP <br /> BILLING ADDRESS(42) 16500 HARLAN <br /> If different from Mailing F71 <br /> 11 <br /> Address,otherwise leave blank Street No. Direction Street Name Street Type <br /> LATHROP CA 95330 <br /> City State ZIP <br /> ADDITIONAL BUSINESS INFORMATION <br /> TYPE OF ®Single Owner ❑Partnership UNSTAFFED SITE NO <br /> ORGANIZATION(43) ❑Corporation ❑Public Agency NETWORK(44) <br /> ASSESSOR PARCEL NO. (45) 1198-210-17 <br /> PROPERTY OWNER (46) PHONE NO.(47) <br /> NAME NICK ARBABIAN 281-293-1000 <br /> (If different from Business Owner) <br /> PROPERTY OWNER (48) <br /> ADDRESS P.O.BOX 690514 <br /> Street Address <br /> STOCKTON CA 95269-0514 <br /> CITY STATE ZIP <br /> FIRE DISTRICT NO. F7 FIRE DISTRICT (49) ILATHROP/MANTECA <br /> NEAREST CROSS (50) F-5 <br /> STREET <br /> FACILITY (51) NO IF YES, N/A <br /> LOCK BOX WHERE IS IT LOCATED?(52) <br /> NATURE OF BUSINESS (53) GAS STATION & SNACK SHOP <br /> WASTE GENERATOR (54) N/A IF YES, <br /> WHAT IS YOUR EPA NO.?(55) N/A <br /> TRADE SECRET (56) D ANSPILL PREVENTION (57) <br /> INFORMATION NO AND COUNTERMEASURES N/A <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: 1/14/04 <br />