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i <br /> BUSINESS OWNER/OPE �21t IDENTIFICATION PAGE I PAGE 2 <br /> 3 BUSINESS MAILING AND BILLING INFORMATION <br /> MAILING ADDRESS (41) <br /> (If different from Site Address) <br /> } NOTE: All time sensitive and r Street No. Direction Street Name Street Type <br /> official correspondence will <br /> be sent to this address <br /> CITY STA'T'E ZIP <br /> BILLING ADDRESS(42) <br /> If different from above; <br /> include"Care of information <br /> ADDITIONAL BUSINESS INFORMATION <br /> TYPE OF ❑ SINGLE OWNER ❑PARTNERSHIP UNSTAFFED SITE NETWORK(44) NO <br /> :.? ORGANIZATION(43) ®CORPORATION ❑PUBLIC AGENCY <br /> ASSESSOR PARCEL NO. (45) <br /> 051-320-09 <br /> PROPERTY OWNER PHONE NO, (47) <br /> NAME (46) <br /> PROPERTY OWNER (48) <br /> ADDRESS <br /> ..jj. <br /> Street Address <br /> ;1 CITY STATE ZIP <br /> FIRE DISTRICT (49 MOKELUMNE FD <br /> NEAREST CROSS (50) <br /> :STREET E LOCKE RD & STATE HWY SS <br /> FACILITY {5+�} N O IF YES, <br /> ,LOCK BOX WHERE IS IT LOCATED?(52) <br /> NATURE OF BUSINESS . (53) REAL ESTATE & EQUIPMENT RENTAL i <br /> :j <br /> 'WASTE GENERATOR {54) YES IF YES, <br /> WHAT IS YOUR EPA NO.?(55) CAC001423264 <br /> :Y <br /> )TRADE SECRET (56) SPILL PREVENTION (57) <br /> INFORMATION NO AND COUNTERMEASURES YES <br /> i 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) YES <br /> :3 <br /> Does your business maintain written training records that show the training subject,date(s)of training, (59) YES <br /> Inames and signatures of employees trained,and names of instructor(s)? <br /> 3 <br /> Data Created 7/29198 Date Modified 7/5101 Last Modified By: Michelle Halliwelf <br /> 5 _ <br />