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VVi _ V LVu7 <br /> BUSINESS OWNER/OPERAT•IDENTIFICATION PAGE , Page 2 <br /> BUSINESS MAILING AND BILLING INFORMATION <br /> UILING ADDRESS(41) 11025 TRADE CENTER DR <br /> different from Site Address, <br /> otherwise leave blank Street No. Direction Street Name Street Type <br /> NOTE: All official mail RANCHO CORDOVA CA 95670 <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 /> F <br /> City State ZIP <br /> ADDITIONAL BUSINESS INFORMATION <br /> TYPE OF ❑Single Owner ❑Partnership UNSTAFFED SITE YES <br /> ORGANIZATION(43) [] Corporation ®Public Agency NETWORK(44) <br /> ASSESSOR PARCEL NO. (45) 177-260-06 <br /> PROPERTY OWNER (46) PHONE NO. (47) <br /> NAME COUNTY OF SAN JOAQUIN 209-468-4700 <br /> (If different from Business Owner) <br /> PROPERTY OWNER (48) 5000 S ' WAY, ROOM 212 <br /> )DRESS <br /> Street Address <br /> STOCKTON CA 95206 <br /> CITY STATE ZIP <br /> FIRE DISTRICT NO. 22 FIRE DISTRICT (49) <br /> NAME STOCKTON <br /> NEAREST CROSS (50) <br /> STREET AIRPORT WAY <br /> FACILITY (51) NO IF YES, <br /> LOCK BOX WHERE IS IT LOCATED?(52) N/A <br /> NATURE OF BUSINESS (53) AVIATION <br /> WASTE GENERATOR (54) NO IF YES, <br /> WHAT IS YOUR EPA NO.?(55) N/A <br /> 7�:: <br /> TRADE SECRET (56) SPILL PREVENTION (57) <br /> INFORMATION NO 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 <br /> .es 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: 719/0 4 <br />