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JAN 'ipp <br /> BUSINESS OWNER/OPERATOR IDENTIFICATION PAGE Page 2 <br /> BUSINESS MAILING AND BILLING INFORMATION <br /> MAILING ADDRESS(41) <br /> If different from Site Address, <br /> otherwise leave blank Street No. Direction Street Name Street Type <br /> NOTE:All official mail goes <br /> will go to this address <br /> City State ZIP <br /> BILLING ADDRESS(42) == <br /> If different from Mailing <br /> Address,otherwise leave blank Street No. Direction Street Name Street Type <br /> City State <br /> � <br /> ZIP <br /> ADDITIONAL BUSINESS INFORMATION <br /> TYPE OF IN Single Owner ❑Partnership UNSTAFFED SITE NO <br /> ORGANIZATION(43) ❑Corporation ❑Public Agency NETWORK(44) <br /> ASSESSOR PARCEL NO. (45) <br /> 179-100-12 <br /> PROPERTY OWNER (46) <br /> NAME LEE &ALICE SCHMIDKE PHONE NO. (47) <br /> 209-477-0910 <br /> (If different from Business Owner) <br /> PROPERTY OWNER (48) <br /> ADDRESS 11243 N HAM LN <br /> Street Address <br /> LODI CA 95242 <br /> CITY STATE ZIP <br /> FIRE DISTRICT NO, 18 FIRE DISTRICT (49) <br /> NAME MONTEZUMA <br /> NEAREST CROSS (50) <br /> STREET MUNFORD & WEST 99 FRONTAGE <br /> FACILITY (51) NOIF YES, <br /> LOCK BOX WHERE IS IT LOCATED?(52) <br /> NATURE OF BUSINESS (53) <br /> SCRAP IRON PROCESSOR & AUTO STORAGE <br /> WASTE GENERATOR (54) YES IF YES, <br /> WHAT IS YOUR EPA NO.?(55) CAD982052565 <br /> TRADE <br /> INFORMA IRET (56) NO SPILL PREVENTION (57) <br /> AND COUNTERMEASURES YES <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 <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)? YDS <br /> DATE REC'D: 1/16/03 <br />