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UNIFIED PROGRAM CONSOLIDATED FORM <br /> FACIIJTV INFORMATION <br /> BUSINESS OWNER/OPERATOR IDENTIFICATION, PAGE 2 <br /> LOCALLY COLLECTED INFORMATION <br /> TYPE OF B ® Cor ❑ Part iershi 13811NRTAFPFn STTFNFTWnRK 139 <br /> nn n_n wrt7 n�rrnwr <br /> ❑ Single Owner Corporation P NO <br /> ACCFRAOR PARCFT.NIlMRF.R 140 NEAREST CROSS STREET 141 <br /> 179-110-08 MARAPOSA <br /> PROPERTY OWNER NAME(If different from Business Owner) 142 1 PHONE NO. 143 <br /> ROBERT HILL 408 297-7906 <br /> PROPERTY OWNER STREET ADDRESS 144 1 PROPERTY OWNER CITY 145 STATE 146 ZIP CODE 147 <br /> 348 PHELAN AVE SAN JOSE CA 95112 <br /> FIRE DISTRICT NAME 14 FIRE DEPT NO. 14 FACILITY LOCK BOX 151 IF YES,WHERE IS IT LOCATED? 151 <br /> MONTEZUMA N/A NO N/A <br /> 152 <br /> N ATT TR F OF RT iSTNRSS <br /> STORAGE FACILITY <br /> WASTE GENERATOR ±1531FS.ENTER EPA NUMBER 154 <br /> NO A <br /> TR AnF.RFC'.RF.T NFORMATION 155 SPILION AND COI WTFRMEASURES PLAN PREPARED FOR FACILITY? 156 <br /> NO YES <br /> TRAINING PROGRAM INFORMATION 157 <br /> YES <br /> Does your business maintain written training records that show the training subject,date(s)of training, <br /> YES <br /> ...d .. ..C.......L........,a_ --A ....A...........—f:...w_......._l.N7 <br /> Rn.I.INC: AnnRRCR If diffwrent from Mailina Addrrcc. nthrrwicr laavr hNn4 <br /> BUSINESS BILLING ADDRESS 158 <br /> BUSINESS BILLING CITY 159 STATE 160 ZIP CODE 161 <br /> This area intentionally left blank <br />