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Alk AM <br /> BUSINESS OWNER/OPERATOR IDENTIFICATION PAGE Page 2 <br /> BUSINESS MAILING AND BILLING INFORMATION <br /> MAILING ADDRESS(dre �= P.O.BOX 30785 <br /> If different from Site Address, <br /> otherwise leave blank Street No. Direction Street Name Street Type <br /> NOTE: All official mail STOCKTON CA 95215 <br /> will go to this address <br /> City State ZIP <br /> BII.LING ADDRESS (42) �� <br /> If different from Mailing <br /> Address,otherwise leave blank Street No. Direction Street Name Street Type <br /> City State ZIP <br /> ADDITIONAL BUSINESS INFORMATION <br /> TYPE OF ❑Single Owner ❑Partnership UNSTAFFED SITE NO <br /> ORGANIZATION(43) N Corporation ❑Public Agency NETWORK(44) <br /> ASSESSOR PARCEL NO. (45) 117917103 <br /> PROPERTY OWNER (46) PHONE NO. (47) <br /> NAME JERRY GUNTER 209-465-3955 <br /> (If different from Business Owner) <br /> PROPERTY OWNER (48) <br /> ADDRESS 3838 S.HWY 99 <br /> Street Address <br /> STOCKTON CA 95215 <br /> CITY STATE ZIP <br /> FIRE DISTRICT NO. FTJ FIRE DISTRICT (49) <br /> NAME MONTEZUMA <br /> NEAREST CROSS (50) CLARK <br /> STREET <br /> FACILITY (51) NG IF YES, NA <br /> LOCK BOX WHERE IS IT LOCATED?(52) <br /> NATURE OF BUSINESS (53) AUTO REPAIR <br /> WASTE GENERATOR (54) YES IF YES, <br /> WHAT IS YOUR EPA NO.?(55) CAL000252185 <br /> TRADE SECRET (56) �� SPILL PREVENTION (57) <br /> INFORMATION YES 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) YES <br /> names and signatures of employees trained,and names of instructor(s)? <br /> DATE REC'D: 5/5/04 <br />