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UNIFIED PROGRAM CONSOLIDATED FORM <br /> FACILITY INFORMATION <br /> BUSINESS OWNERIOPERATOR IDENTIFICATION,PAGE 2 <br /> LOCALLY COLLECTED INFORMATION <br /> (03/22/2011 - 11:02:41 AM) <br /> ORGANIZATION ®Single Owner ❑Partnership 13 UNST FFED SITE NETWORK 13 <br /> ❑Corporation ❑Public Agency NO <br /> ASSESSOR PARCEL NUMBER 140 NEAREST CROSS STREET 141 <br /> 221-110-37 POWERS AVE <br /> PROPERTY OWNER NAME(If different from Business Owner) 142 1 PHONE NO. 143 <br /> GEORGE PHILLIPS 209-401-8511 <br /> PROPERTY OWNER STREET ADDRESS 144 PROPERTY OWNER CITY 145 STATE 146 ZIP CODE 147 <br /> COTTAGE AVE MANTECA CA 95336 <br /> FIRE DISTRICT NAME 14 FIRE DEPT NO. 14 FACILITY LOCK BOX 15 IF YES,WHERE IS IT LOCATED? 151 <br /> MANTECA FD 24 NO N/A <br /> NATURE OF BUSINESS 152 <br /> AUTO SERVICE&REPAIR <br /> WASTE GENERATOR 153 IF YES,ENTER EPA NUMBER 154 <br /> YES CAL000294252 <br /> TRADE SECRET INFORMATION 155 SPILL PREVENTION AND COUNTERMEASURES PLAN PREPARED FOR FACILITY? 156 <br /> NO YES <br /> TRAINING PROGRAM INFORMATION 157 <br /> Does your business have an employee training program that includes initial training and annual refreshers? NO <br /> Does your business maintain written training records that show the training subject,date(s)of training, NO <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 I,5 <br /> BUSINESS BILLING CITY 159 STATE 160 ZIP CODE I c <br /> This area intentionally left blank <br />