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UNIFIED PROGRAM CONSOLIDATED FORM <br /> FACILITY INFORMATION <br /> BUSINESS OWNER/OPERATOR IDENTIFICATION,PAGE 2 <br /> LOCALLY COLLECTED INFORMATION <br /> (01/27/2011-09:03:12 AM) <br /> TYPE OF 138 UNSTAFFED SITE NETWORK 139 <br /> ORGANIZATION ❑Single Owner ®Partnership <br /> ❑Corporadon ❑Public Agency NO <br /> ASSESSOR PARCEL NUMBER 140 NEAREST CROSS STREET 141 <br /> 179.171.010&134 HWY 99/FRONTAGE RD <br /> PROPERTY OWNER NAME(If different from Business Owner) 142 1 PHONE NO. 143 <br /> JOE FASO 209.481-1411 <br /> PROPERTY OWNER STREET ADDRESS 144 PROPERTY OWNER CITY 145 STATE 146 ZIP CODE 147 <br /> 4453 YACHT HARBOR DR STOCKTON CA 95206 <br /> FIRE DISTRICT NAME 1417 DEPT NO.149 FACB.rrY LOCK BOX 150 IF YES,WHERE IS rr LOCATED? 151 <br /> MONTEZUMA 18 NO <br /> NATURE OF BUSINESS 152 <br /> AUTO DISMANTLING <br /> WASTE GENERATOR 153 IF YES,ENTER EPA NUMBER 154 <br /> YES CAL000269375 <br /> TRADE SECRET INFORMATION 155 SPILL PREVENTION AND COUNTERMEASURES PLAN PREPARED FOR EACH=? 156 <br /> NO YES <br /> TRAINING PROGRAM INFORMATION 157 <br /> Does your business have an employce training program that includes initial training and annual refreshers? YES <br /> Does your business maintain written training records that show the training subject,date(s)of training, YES <br /> names and signatures of employees trained,and names of instructor(s)? <br /> BILLING ADDRESS If different from Mailing Address,otherwise leave blank <br /> BUSINESS BILLING ADDRESS 158 <br /> BUSINESS BILLLING CrrY 159 STATE 160 ZIP CODE 161 <br /> This area intentionally left blank <br />