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.... .... ......... . . ......... <br /> .......... <br /> --------- .. --- ...... <br /> 0 <br /> UNIFIED PROGRAM CONSOLIDATED FORM <br /> FACILITY INFORMATION <br /> BUSINESS OWNER/OPERATOR IDENTIFICATION, PAGE 2 <br /> LOCALLY COLLECTED INFORMATION <br /> TYPE OF Single ❑Owner 1:1 Corporation ❑El Partnership 138JTTN-TAFFFT)qTW7 WORK 139 <br /> ���-A XTT7 A mT�NT NO <br /> A(;OF.qvnR PARCFT.W1MRF.R 1401 NEAREST CROSS STREET 141 <br /> 179-100-12 MUNFORD&W 99 FRONTAGE <br /> PROPERTY OWNER NAME(If different from Business Owner) 1421 PHONE NO. 143 <br /> STEVEN SCHMIDKE 209-823-7950 <br /> PROPERTY OWNER STREET ADDRESS 144 1 PROPERTY OWNER CITY 145 STATE 1411ZIP CODE 147 <br /> 9044 SOUTHLAND ROAD MANTECA CA 95336 <br /> FIRE DISTRICT NAME 148 FIRE DEPT NO. 14 FACILITY LOCK BOX 1511F YES,WHERE IS IT LOCATED? 151 <br /> MONTEZUMA 18 NO <br /> NATITRF.OF RlTqTtJF.q.q 152 <br /> USED PARTS SALES,AUTO DISMANTLING <br /> WASTE GENERATOR 153 IF YES.ENTER EPA NUMBER 154 <br /> YES CAL000354819 <br /> TRAT)F.RF.C.RFT TNFnRk4ATIC)N 1551 SPILL PREVENTION AND COT TNTFRMEASURES PLAN PREPARED FOR FACILITY? 156 <br /> NO YES <br /> TRAINING PROGRAM INFORMATION 157 <br /> :-:+:-I YES <br /> Does your business maintain written training records that show the training subject date(s)of training, YES <br /> --:--A --A---^1Z..........'-%O <br /> Ryl,T.INV- AnDRF.lq lfdiM .t f,..Mailing Add,.m nthrr i—laavr hin-k <br /> BUSINESS BILLING ADDRESS 158 <br /> BUSINESS BILLING CITY 1111 STATE ZIP CODE 161 <br /> This area intentionally left blank <br />