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UNIFIED PROGRAM CONSOLIDATED FORM <br /> FACILITY INFORMATION <br /> BUSINESS OWNER/OPERATOR IDENTIFICATION,PAGE 2 <br /> LOCALLY COLLECTED INFORMATION <br /> (03/22/2011 - 10:51:41 AM) <br /> ORGANIZATION ®Single Owner ❑Partnership <br /> ❑Corporation ❑Public Agency NO <br /> ASSESSOR PARCEL NUMBER 140 NEAREST CROSS STREET 141 <br /> 041-340-04 S DAISY&N TURNER RD <br /> PROPERTY OWNER NAME(If different from Business Owner) 142 PHONE NO. 143 <br /> JIM LOOCK 209 333 2556 <br /> PROPERTY OWNER STREET ADDRESS 144 PROPERTY OWNER CITY 145 STATE 146 ZIP CODE 147 <br /> 423 1/2 POPLAR ST LODI CA 95740 <br /> FIRE DISTRICT NAME 148 FIRE DEPT NO. 149 FACILITY LOC�BOX �YES, �ITATED? 151 <br /> LODI FD 20 NO <br /> 152 <br /> NATURE OF BUSINESS <br /> EXHAUST REPAIR-MUFFLERS,CONVERTERS <br /> WASTE GENERATOR 153 IF YES,ENTER EPA NUMBER 154 <br /> NO N/A <br /> TRADE SECRET INFORMATION 155 SPILL PREVENTION AND COUNTERMEASURES PLAN PREPARED FOR FACILITY? 156 <br /> NO N/A <br /> TRAINING PROGRAM INFORMATION 157 <br /> Does your business have an employee training program that includes initial training and annual refreshers? YES <br /> dates of training, YES <br /> Does your business maintain written training records that show the training subject, O g, <br /> names and signatures of employees trained,and names of instructor(s)? <br /> BILLING ADDRESS If different from Mailing Address,otherwise leave blank <br /> 158 <br /> BUSINESS BILLING ADDRESS <br /> BUSINESS BILLING CITY 159 STATE 160 ZIP CODE 161 <br /> This area intentionally left blank <br />