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BUSINESS OWNER/OPERATOR IDENTIFICATION PAGE Page 2 <br /> BUSINESS MAILING AND BILLING INFORMATION <br /> MAu-INGADDRESS(41) 9330 BALBOA AVE <br /> If different from Site Address, <br /> otherwise leave blank Street No. Direction Street Name Street Type <br /> NOTE:All official mail SAN DIEGO CA 92123-1516 <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 ZIP <br /> ADDITIONAL BUSINESS INFORMATION <br /> TYPE OF ❑Single Owner ❑Partnership UNSTAFFED SITE NO <br /> ORGANIZATION(43) ®Corporation ❑Public Agency NETWORK(44) <br /> ASSESSOR PARCEL NO. (45) 179-310-02 <br /> PROPERTY OWNER (46) PHONE NO.(47) <br /> NAME JACK IN THE BOX INC 858-571-2689 <br /> (If different from Business Owner) <br /> PROPERTY OWNER (48) <br /> ADDRESS 19330 BALBOA AVE <br /> Street Address <br /> SAN DIEGO CA 92123-1516 <br /> CITY STATE ZIP <br /> FIRE DISTRICT NO. 22 FIRE DISTRICT (49)NAME STOCKTON FD <br /> NEAREST CROSS (50) F;C�/ WY 99 <br /> STREET <br /> FACILITY (51) NO IF YES' N/A <br /> LOCK BOX WHERE IS IT LOCATED?(52) <br /> NATURE OF BUSINESS (53) FAST FOOD RESTAURANT <br /> WASTE GENERATOR (54) NO IF YES, N/A <br /> WHAT IS YOUR EPA NO.. (55) <br /> TRADE SECRET (56) DSPNIDLCPORUENTEENRTION U (57) <br /> INFORMATION NMEAS <br /> NO <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: 1/18/05 <br />