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UNIFIED PROGRAM CONSOLIDATED FORM <br /> FACIIJTV INFORMATION <br /> BUSINESS OWNER/OPERATOR IDENTIFICATION, PAGE 2 <br /> LOCALLY COLLECTED INFORMATION <br /> TYPE OF138TiNSTAFFFTISTTFNFTWDRTC 139 <br /> n7)0-ANTT 7 ATrnal ❑ Single Owner ® Corporation []Partnership <br /> NO <br /> ACRFRRCIR PARCRI.NITMRFR 140 NEAREST CROSS STREET 141 <br /> 198-060-04 LATHROP AVE <br /> PROPERTY OWNER NAME(If different from Business Owner) 142 PHONE NO. 143 <br /> GANN INVESTMENTS 209-858-9766 <br /> PROPERTY OWNER STREET ADDRESS 144 PROPERTY OWNER CITY 145 STATE 146 ZIP CODE 147 <br /> 15300 S. MCKINLEY AVE LATHROP CA 95330 <br /> FIRE DISTRICT NAME 148 FIRE DEPT NO. 111 FACILITY LOCK BOX 151 IF YES,WHERE IS IT LOCATED? 151 <br /> LATHROP-MANTECA FIRE N/A YES FRONT LEFT CORNER OF FRONT <br /> TTCTOif"T n nn �,+nl ni �iw,n <br /> WATT TR P OF RT ICINFSS 152 <br /> STUCCO/PLASTERING CONTRACTOR <br /> WASTE GENERATOR 153 IF YES.ENTER EPA NUMBER 154 <br /> YES CAL000220869 <br /> TRADF.AFCRF.T INFnRMATInN 155 SPILL PREVENTION AND COI INTER MEASURES PLAN PREPARED FOR FACILITY? 156 <br /> NO YES <br /> TRAINING PROGRAM INFORMATION 157 <br /> ......_ .. :__ __ _,_..__ :_:_ _. _ .w,..:-..1-A-_ YES <br /> Does your business maintain written training records that show the training subject,date(s)of training. YES <br /> ......_A..a..n... ......Cn.....,n......n._ :--A --J---..0:---------1-10 <br /> RTT.I.INO ATNIRFSS If diffnrrnt from Meilino Addrncc nth.,wk.Inavn hlan4 <br /> BUSINESS BILLING ADDRESS 158 <br /> BUSINESS BILLING CITY 159 SPATE 160 ZIP CODE 161 <br /> This area intentionally left blank <br />