Laserfiche WebLink
I BUSINESS OWNER/OPERATOR IDENTIFICATION FORM I SIDE 2 <br /> BUSINES AILING AND BILLING INFORNWhON <br /> MAILING ADDRESS (41) n <br /> (If different from Site Address) O �2 FRo N-rA�I C, R[ I <br /> NOTE: All time sensitive and Street No. Direction Street Name Stree�t'1 <br /> ial correspondence will YP <br /> ent to this address <br /> CITY STATE ZIP <br /> BILLING ADDRESS (42) <br /> If different from above, <br /> include"Care of information � <br /> ADDITIONAL BUSINESS INFORMATION <br /> TYPE OF ngle Owner ❑Public Agency UNSTAFFED SITE NETWORK(44)ORGANIZATION (43) E�l <br /> orporation <br /> artnershi <br /> ASSESSOR PARCEL NO.(45) <br /> PROPERTY OWNER (46) PHONE NO.(47) <br /> NAME 1 <br /> (If different from Business Owner " GVLL1� C� �l� Gd. L001" pp-z336 <br /> ADDR PROPERS3 OWNER (48) n M 1 C��_ <br /> 6 Street Address <br /> • s ZZ 914CPU- G'Zo) <br /> CITY STATE ZIP <br /> FIRE DISTRICT (49) <br /> NEAREST CROSS (50) <br /> STREET r✓0 LOFACILITY 1� �. � � .11�CA� Z1FJ� • �29 NI�[U 1 � <br /> LOCK OX (5]) S O IF WHERE <br /> x\11 1 <br /> WHERE IS IT LOCATED?(52) <br /> NATURE OF BUSINESS (53) <br /> WASTE GENERATOR (54) IF YES, <br /> �YS O WHAT IS YOUR EPA NO:?(55) <br /> TRADE SECRET (56) SPILL PREVENTION <br /> (5'n <br /> INFORMATION Q AND COUNTERMEASURES �I�f <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) PITS Do <br /> your business maintain written training records that show the training subject,date(s)of training, (59)� <br /> s and signatures of employees[rained,and names of instructor(s)? �O <br /> 12/08 <br />