Laserfiche WebLink
UNIFIED PROGRAM CONSOLIDATED FORM <br /> FACILITY INFORMATION <br /> BUSINESS OWNER/OPERATOR IDENTIFICATION, PAGE 2 <br /> LOCALLY COLLECTED INFORMATION <br /> TYPE OF138 T INSTAFFFD STTFNFTWCIRK 139 <br /> r Dn -AI.,TOAT1/lAl ❑ Single Owner ® Corporation El Partnership <br /> NO <br /> ASSESSOR PARCT.T.NTTMRFR 140 NEAREST CROSS STREET 141 <br /> 179-200-34 ARCH RD <br /> PROPERTY OWNER NAME(If different from Business Owner) 142 PHONE NO. 143 <br /> FEDEX FREIGHT,INC. 408-323-4561 <br /> PROPERTY OWNER STREET ADDRESS 144 PROPERTY OWNER CITY 145 STATE 146 ZIP CODE 147 <br /> 2200 FORWARD DR. HARRISON AR 72601 <br /> FIRE DISTRICT NAME 148 FIRE DEPT NO. 141 FACILITY LOCK BOX 15 IF YES,WHERE IS IT LOCATED? 151 <br /> MONTEZUMA FD 18 YES FRONT WALL OF OFFICE BLDG <br /> NATTIRF OF R110MRSS 152 <br /> TRUCKING TERMINAL <br /> WASTE GENERATOR 153 IF YES.ENTER EPA NUMBER 154 <br /> YES CAL000167732 <br /> TR ADR SFC`RFT INFORMATTON 155 SPILL PREVENTION AND COT INTF.RMEASURES PLAN PREPARED FOR FACILITY? 156 <br /> NO YES <br /> TRAINING PROGRAM INFORMATION 157 <br /> _.r.-.:_ ,.. _ :_:.: ,w :_:__ _ ..--...., YES <br /> Does your business maintain written training records that show the training subject,date(s)of training, YES <br /> RII LING AnnRFRs if r iMfr .f frnm Mailing Addy..,nfhnrwica Innvw hlnn4 <br /> BUSINESS BILLING ADDRESS 158 <br /> BUSINESS BILLING CITY 159 STATE 160 ZIP CODE 161 <br /> This area intentionally left blank <br />