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• 0 <br /> UNIFIED PROGRAM CONSOLIDATED FORM <br /> FACTTdTV INFORMATInN <br /> BUSINESS OWNER/OPERATOR IDENTIFICATION, PAGE 2 <br /> LOCALLY COLLECTED INFORMATION <br /> TYPE OF13811 1NCTAFFFT)CTTF.NFTWORK 139 <br /> ® Single Owner El Corporation El Partnership <br /> nn r_n w\\o n�rnw* NO <br /> ASSFCCOR PARCF.I.NTIMRRR 140 NEAREST CROSS STREET 141 <br /> 7451015004 STOCKTON STREET <br /> PROPERTY OWNER NAME(If different from Business Owner) 142 PHONE NO. 143 <br /> TOM MARAGLIANO 209-463-2641 <br /> PROPERTY OWNER STREET ADDRESS 144 1 PROPERTY OWNER CITY 145 STATE 146 ZIP CODE 147 <br /> 775 W.2ND STREET STOCKTON CA 95206 <br /> FIRE DISTRICT NAME 148 FIRE DEPT NO. 149 FACILITY LOCK BOX 151 IF YES,WHERE IS IT LOCATED? 151 <br /> STOCKTON CA STATI NO N/A <br /> WATT TRF.nF RT lR1NF.C8 152 <br /> EXCAVATING <br /> WASTE GENERATOR 153 1 IF YES.ENTER EPA NUMBER 154 <br /> NO N/A <br /> TR ADF.SRCRFT INFnRMATTnw 155 SPILL PREVENTION AND COI INTERMEASURES PLAN PREPARED FOR FACILITY? 156 <br /> NO NO <br /> TRAINING PROGRAM INFORMATION 157 <br /> n............_L....:.......1........... .......1........._..:..:....__...._......6...:....L.J....:..:.:a....:..:......_A..........1_..a...6.....n YES <br /> Does your business maintain written training records that show the training subject,date(s)of training, YES <br /> RIT.T.TNR AnnRN.Rfi If different frnm Mailina Aridre¢c. ntherwice leave hlnn4 <br /> BUSINESS BILLING ADDRESS 158 <br /> BUSINESS BILLING CITY 159 STATE 160 ZIP CODE 161 <br /> This area intentionally left blank <br />