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DEC 35 ZUK <br />AM <br />BUSINESS OWNER/OPERA OR IDENTIFICATION PAGE Page 2 <br />MAILING ADDRESS (41) <br />If different from Site Address, <br />BUSINESS MAILING AND BILLING INFORMATION <br />�= P.O. BOX 806 <br />otherwise leave blank Street No. Direction Street Name Street Type <br />NOTE: All official mail RIPON CA 95366-0806 <br />will go to this address <br />City State ZIP <br />BILLING ADDRESS ) �� <br />If different from Mailiailinngg <br />Address, otherwise leave blank Street No. Direction Street Name Street Type <br />Citv State ZIP <br />TYPE OF <br />ORGANIZATION (43) <br />ASSESSOR PARCEL NO. (45) <br />ADDITIONAL BUSINESS INFORMATION <br />❑ Single Owner ❑ Partnership UNSTAFFED SITE NO <br />® Corporation ❑ Public Agency NETWORK (44) <br />261-020.07 & 261.020-11 <br />PROPERTY OWNER (46) PHONE NO. (47) <br />NAME RIPON FARM SERVICE 209-599-2188 <br />(If different from Business Owner) <br />PROPERTY OWNER (48) <br />ADDRESS <br />938 FRONTAGE RD. <br />Street Address <br />RII'ON CA 95366 <br />CITY STATE ZIP <br />FIRE DISTRICT NO.MEDISTRICT (49) RIPON FIRE DIST <br />NEAREST CROSS (50) <br />STREET I JACK TONE RD <br />FACILITY (51) YES IF YES, YRUN'1' EN'1'KA. <br />LOCKBOX WHERE IS IT LOCATED? (52) ffE2L4TAGE RD <br />NATURE OF BUSINESS (53) <br />AG CHEMICAL <br />WASTE GENERATOR (54) NO IF YES, <br />WHAT IS YOUR EPA NO.? (55) N/A <br />TRADE SECRET (56) ANSPILL PREVENTION (57) <br />INFORMATION NO AND COUNTERMEASURES 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: 12/28/04 <br />