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BUSINESS OWNER/OPEI&OR IDENTIFICATION FORM• I SIDE 2 <br /> BUSINESS MAILING AND BILLING INFORMATION <br /> MAILING ADDRESS (41) �#2� <br /> (If different from Site Address) <br /> NOTE: All time sensitive and Street No. DirectionStreet Name Street Type <br /> official correspondence will G� <br /> be sent to this address s� ToSt 2— <br /> CITY STATE _ ZIP <br /> BILLING ADDRESS(42) AVE. D <br /> If different from above, 6�✓� <br /> include"Care of information <br /> 'Sea69mv.".nry uuuNl V <br /> ADDITIONAL BUSINESS INFORMATION <br /> TYPE OF ❑Single Owner ❑Partnership UNSTAFFED SITE NETWORK(44) ❑yESNO <br /> ORGANIZATION (43) Corporation ❑Public Agency <br /> ASSESSOR PARCEL NO. (45) <br /> PROPERTY OWNER OWNER (46) PHONE NO. (47) <br /> NAME <br /> (If different from Business Owner) <br /> PROPERTY OWNER (48) <br /> ADDRESS <br /> Street <br /> L <br /> CITY STATE ZIP <br /> FIRE DISTRICT (49) <br /> o Zv w <br /> NEAREST CROSS (50) <br /> STREET <br /> FACILITY (51) 1F YES, <br /> LOCK BOX YES ❑NO WHERE IS IT LOCATED?(52) i1111 <br /> 1 44--11 ��/�C •� <br /> NATURE OF BUSINESS (53) T <br /> WASTE GENERATOR (54) IF YES, E: <br /> �JYES ❑NO WHAT IS YOUR EPA NO (55) �� 2 <br /> TRADE SECRET (56) SPILL PREVENTION (57) <br /> INFORMATION //O AND COUNTERMEASURES <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 ❑NO <br /> Does your business maintain written training records that show the training subject,date(s)of training, (59) YES ❑NO <br /> names and signatures of employees trained, and names of instructor(s)? <br /> 12/00 <br />