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UNIFIED PROGRAM CONSOLIDATED FORM <br /> FAVILITV INFORMATION <br /> BUSINESS OWNER/OPERATOR IDENTIFICATION, PAGE 2 <br /> LOCALLY COLLECTED INFORMATION <br /> TYPE OF13 1 TNSTAFFRT)9TTF NFTW0RK 139 <br /> nn n A ATT7 A 9TnXT ❑ Single Owner ® Corporation []Partnership <br /> NO <br /> ASSFSBOR PARCFI.NTTMRFR 140 NEAREST CROSS STREET 141 <br /> 017-090-31 WOODBRIDGE RD&HWY 99 <br /> PROPERTY OWNER NAME(If different from Business Owner) 142 1 PHONE NO. 143 <br /> DENNIS ALEXANDER 209-368-3160 <br /> PROPERTY OWNER STREET ADDRESS 144 PROPERTY OWNER CITY 145 STATE 146 ZIP CODE 147 <br /> 21900 N DEVRIES LODI CA 95240 <br /> FIRE DISTRICT NAME 14 FIRE DEPT NO. 141 FACILITY LOCK BOX 151 IF YES,WHERE IS IT LOCATED? 151 <br /> WOODBRIDGE 7 NO N/A <br /> NATT TRF OF RT TSTNFSS 152 <br /> AG PROCESSOR GRAPES/GRAIN <br /> WASTE GENERATOR 153 IF YES.ENTER EPA NUMBER 154 <br /> NO N/A <br /> TR ADP.RRCRRT WFORMATION 155 SPILL PREVENTION AND COl rNTFRMEASURES PLAN PREPARED FOR FACILITY? 156 <br /> NO NO <br /> TRAINING PROGRAM INFORMATION 157 <br /> n„_........_�.....:........w,,...............i.......,«..:_:_..__.,.........w...:...:.a—:..:.:_:._..:..:_,..._a___..A_..a.._:......n YES <br /> Does your business maintain written training records that show the training subject,date(s)of training, YES <br /> RIT LTNfl Annnvrr If dlffrrrnt from Mailina Addrrcc.athrrwi.a Iwavn h1nn4 <br /> BUSINESS BILLING ADDRESS 158 <br /> BUSINESS BILLING CITY 159 STATE 160 ZIP CODE 161 <br /> This area intentionally left blank <br />