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BUSINESS OWNER/OPERATOR IDENTIFICATION PFFB SIDE 2 <br /> BUSINESS MAILING AND BILLING IN 6* AMM <br /> MAILING ADDRESS (41) P.O. Box 52085 IFFICEOF&AEHGEN SE' <br /> If different from Site Address Street No. Direction Street Name Street Type <br /> Phoenix AZ 85072-2085 <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 UNMANNED SITE NETWORK(44) t YES ❑X NO <br /> ORGANIZATION (43) <br /> BUSINESS LICENSE NO. (45) 9800276 EXPIRATION DATE(46) <br /> ASSESSOR PARCEL NO. (47) 198-210-17 <br /> PROPERTY OWNER (48) Conoco Phillips PHONE NO. (49) (602) 728-4970 <br /> NAME <br /> (If different from Business Owner) <br /> PROPERTY OWNER (50) P.O. Box 52085 <br /> ADDRESS <br /> Street Address <br /> Phoenix AZ 85072-2085 <br /> CITY STATE ZIP <br /> FIRE DISTRICT (51) <br /> NEAREST CROSS (52) Harlan <br /> STREET <br /> FACILITY (53) 1 YES IFINO IF YES, <br /> LOCK BOX WHERE IS IT LOCATED? (54) <br /> NATURE OF BUSINESS (55) Gas Station <br /> WASTE GENERATOR (56) r YES r NO FIFYES, <br /> IS YOUR EPA NO? (57) <br /> TRAINING PROGRAM INFORMATION <br /> Does your business have an employee training program that includes initial training and annual refreshers? (58) ❑x YES r NO <br /> Does your business maintain written training records that show the training subject, date(s)of training, (59) ®YES C NO <br /> names and signatures of employees trained, and names of instructor(s)? <br /> SJC 12/99 <br />