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BUSINESS OWNER/OPERATOR IDENTIFICATION FORM SIDE 2 <br /> BUSINESS MAILING AND BILLING INFORMATION <br /> Of�EpflJEME U6_ �UtuyJ � <br /> (If different from Site Address) (5?0/ ///!� � z <br /> NOTE: All time sensitive and Street No. Direction Street Name Street Type <br /> official correspondence will A <br /> be sent to this address C Lo <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 F-1PartnershipUNSTAFFED SITE NETWORK(44) �YPS ®NO <br /> ORGANIZATION (43) Corporation ❑Public Agency <br /> ASSESSOR PARCEL NO. (45) <br /> PROPERTY OWNER (46) PHONE NO.(47) --o 941— <br /> NAME <br /> 41 NAME <br /> (If different from Business Owner) <br /> PROPERTY OWNER (48) a C' �Q �Q Q bfOQoL <br /> ADDRESS y9 <br /> Street Address <br /> Me <br /> CITY STATE ZIP <br /> FIRE DISTRICT (49) / <br /> NEAREST CROSS (50) Lal B/ 11C <br /> STREET <br /> FACILITY (51) IF YES, <br /> LOCK BOX AYES ®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) A114INFORMATIONQ,(fQi 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 /> 12100 <br />