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BUSINESS OWNER/OPERATOR IDENTIFICATION FORM SIDE 2 <br /> BUSINESS MAILING AND BILLING INFORMATION <br /> MAILING ADDRESS(41) hh �^ I '' <br /> (If different from Site Address) �F V F�l JX `T� <br /> NOTE: All time sensitive and Street No. Direction Street Name Street Type <br /> official correspondence will <br /> be sent to this address bQ (-� �d— <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 ❑Partnership I UNSTAFFED SITE NETWORK(44) ❑YES �NO <br /> ORGANIZATION (43) Corporation ❑Public Agency <br /> ASSESSOR PARCEL NO. (45) <br /> PROPERTY OWNER (46) PHONE NO.(47) <br /> NAME A -L P0q-2 --/gip <br /> JO <br /> (If different from Business Owner) <br /> PROPERTY OWNER (48) <br /> ADDRESS <br /> �J W Street Address <br /> g52-2D <br /> CITY STATE ZIP <br /> FIRE DISTRICT (49) <br /> Woodbrid�� <br /> NEAREST CROSS (50) <br /> STREET <br /> FACILITY (51) IF YES, <br /> LOCKBOX ❑YESNO WHERE IS IT LOCATED?(52) <br /> NATURE OF BUSINESS (53) <br /> Wa ��,r will drilli q►�d pump <br /> WASTE GENERATOR (54) IF YES, <br /> ❑YES �NO WHAT IS YOUR EPA NO.?(55) <br /> TRADE SECRET (56) �SPILL PREVENTION (57) f 1 <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 />