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Ak <br /> VV <br /> BUSINESS OWNER/OPERATOR IDENTIFICATION FORNr SIDE 2 <br /> BUSINESS MAILING AND BILLING INFORMATION <br /> MAILING ADDRESS(41) /� <br /> (If different from Site Address) tTj <br /> NOTE: All time sensitive and Street No. Direction Street Name t <br /> official correspondence will JAN 12 2001 <br /> be sent to this address Cj] ctc'l q —zE� i <br /> CITY STATE ZM JOAQUIN COUNTY <br /> N Hee OF EMER8ENeY SE, <br /> S <br /> BILLING ADDRESS(42) <br /> If different from above, <br /> include"Care of information <br /> ADDITIONAL BUSINESS INFORMATION <br /> TYPE OF ❑Single Owner ❑Partnership UNSTAFFED SITE NETWORK(44) �yF.S NO <br /> ORGANIZATION (43) PqCorporation ❑Public Agency <br /> ASSESSOR PARCEL NO. (45) <br /> OC � <br /> PROPERTY OWNER (46) PHONE NO. (47) <br /> NAME <br /> (If different from Business Owner) <br /> PROPERTY OWNER (48) <br /> ADDRESS <br /> D _5e) i 'x"'211 \.U1�'` <br /> Street Address <br /> CITY STATE ZIP <br /> FIRE DISTRICT 9) <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 <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 /> 12/00 <br />