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RECEIVED <br /> • UNIFIED PROGRAM CONSOLIDATED FORM Jb - 2008 <br /> FACILITY INFORMATION bHN JUNUUIIV UUUN I <br /> BUSINESS OWNER/OPERATOR IDENTIFICATIOIY�(cEOFEMERGENCY sERwc <br /> Pae 2 of 10 <br /> I. IDENTIFICATION <br /> FACILITY ID# 1. BEGINNING DATE 100. ENDING DATE IOL <br /> (Agency Use Only) December 12,2005 December 12,2006 <br /> BUSINESS NAME(Same az FACILITY NAME.,DBA-Doing Busi..As) 3. BUSINESS PHONE 102. <br /> GMRI, Inc. DBA Red Lobster#381 2094732420 <br /> BUSINESS SITE ADDRESS 103. <br /> 2283 W. MARCH LANE <br /> CITY 104. ZIP CODE 105. <br /> STOCKTON CA 95207-6631 <br /> DUN&BRADSTREET 106. SIC CODE(4 digit#) 107. <br /> N/A 5812 <br /> COUNTY 108. <br /> San Joaquin <br /> BUSINESS OPERATOR NAME 109. BUSINESS OPERATOR PHONE 110. <br /> GMRI,Inc. 407-245-4000 <br /> IL BUSINESS OWNER <br /> OWNER NAME "I. OWNER PHONE 112. <br /> Darden Restaurants,Inc. Attention: Risk Management 407-245-4000 <br /> OWNER MAILING ADDRESS 113' <br /> P.O.Box 593330 <br /> CITY Ila. STATE 115. ZIP CODE 116. <br /> Orlando I FL 32859-3330 <br /> 1111. ENVIRONMENTAL CONTACT <br /> CONTACT NAME 117. CONTACT PHONE Its. <br /> Thomas Cipollone 407-245-5198 <br /> CONTACT MAILING ADDRESS 119. <br /> P.O.Box 593330 <br /> CITY 120. STATE 121. ZIP CODE 122. <br /> Orlando FL 32859-3330 <br /> -PRIMARY- IV. EMERGENCY CONTACTS -SECONDARY- <br /> NAME 123. NAME 128. <br /> Jim McKeating Thomas Cipollone <br /> TITLE 124. TITLE 129, <br /> Senior Vice President Operations Director Risk Management <br /> BUSINESS PHONE 125. BUSINESS PHONE 130. <br /> 480-483-2455 407-245-5198 <br /> 24-HOUR PHONE* 126. ._ .. BE <br /> 602-751-1113 407-496-8141 <br /> PAGER# 127. PAGER# 132. <br /> N/A N/A <br /> ADDITIONAL LOCALLY COLLECTED INFORMATION: 133. <br /> Property Owner: N/A Phone No.: <br /> Billing Address: <br /> Certification: Based on my inquiry of those individuals responsible for obtaining the information,I certify under penalty of law that I have personally examined and <br /> am familiar with the information submitted and believe the information is true,accurate,and complete. <br /> SIGNATURE OF OWNER/OPERATOR OR DESIGNATED REPRESENTATIVE DATE 134. NAME OF DOCUMENT PREPARER SIG <br /> Dec. 21,2007 Thomas Ci )Ilone NAT <br /> NAME OF SIGNER(print) 136. TITLE OF SIGNER 137. <br /> Thomas Cipollone Director Risk Management <br /> •See Instructions on next page. <br /> www.unidoes.org Rev.12/12/06 <br />