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06/14/2005 10:14 2093399AQ7 SANBORN CHEVRP ET PAGE 03 <br /> Iffer <br /> NESS OWNE OPERATOR IDENTIFICATION FORM SIDE 2 <br /> B� SINESS MAILING AND BILLING INFORMATION <br /> DRESS (41) <br /> om Site Address) L - ��?`f- JU5-7 <br /> ime sensitive and Street No. Direction Street Name Street Type <br /> pondence w;11 address ( , g <br /> CITY STATE ZIP <br /> BILLIN ADDRESS (42) <br /> If differe t from above, <br /> include ' .are of information <br /> ADDITIONAL BUSINESS INFORMATION <br /> TYPE ❑ Single Owner ❑Partnership UNSTAFFED SITE NETWORK ❑YES ❑NO <br /> ORCjA _ATION (43) Corporation ❑Public Ag.ncy <br /> ASSESS DR PARCLL NO. (45) <br /> PROPEI TY OWNER (46) PHONE NO. (47) <br /> NANIL <br /> II diffcr nt from Business Owncr) <br /> PROPS TY OWNER (43) <br /> :kDDR S <br /> Street Address <br /> CITY STATE ZIP <br /> FIRE D TRICT (49) <br /> NEARS T CROSS (50) <br /> SIRE IKe e .,� "A �-- <br /> FACILI Y (51) IF YES, <br /> LOCK X ❑YES �NOJ WHERE IS IT LOCATED?(52) <br /> NAT OF BUSINESS (53) <br /> 1�1b r <br /> WASENERATOR (54) IF YES, <br /> 10YES ❑NO WHAT IS YOUR EPA NO.?(55) AD >41-5 <br /> TRADE ECRET (56) SPILL PREVENTION (57) <br /> INFOR ATION AND COUNTERNIEASURES <br /> PLAN FOR THIS FACILITY <br /> TRAINING PROGRAM INFOW IATION <br /> Does yor business have an employ e training program that includes initial training and annual refreshers? (53) YES [7]N?Does yoId <br /> r business maintain writte training record; that show the training subject.date(s) of training. 09) <br /> names a s;gnatures of cmployees trained, and names of instructuns)" 6 LYFS []NO <br /> l?iG. <br />