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DEC a 8 201A <br /> Account#: 949 <br /> I. IDENTIFICATION <br /> BUSINESS NAME (4) RED LOBSTER#381 BUSINESS PHONE(5) 209-473-2420 <br /> SITE ADDRESS (6) 2283 [W] MARCH LN <br /> Street No. Direction StreetName StreetT e A Eld Suite <br /> CITY (7) STOCKTON STATE(8)F— <br /> CA ZIP(9) 95207 <br /> DUN& (10) 052102555 SIC CODE(4 DIGIT#)(11) 5812 <br /> BRADSTREET <br /> OPERATOR (12) MARK RUTLEDGE, GEN OPERATOR PHONE(13) 209-473-2420 <br /> NAME MGR <br /> II. BUSINESS OWNER <br /> OWNER NAME(14) GMRI INC OWNER PHONE(15) 407-245-5398 <br /> OWNER MAILING ADDRESS(16) P.O. BOX 59330 <br /> (If different from site address) <br /> CITY(17) ORLANDO STATE(18) ZIP(19) 32859-3330 <br /> III. ENVIRONMENTAL CONTACT <br /> CONTACT NAME(20) MARK RUTLEDGE CONTACT PHONE(21) 209-941-9731 <br /> MAILING ADDRESS(22) ❑ <br /> (If different from business <br /> mailing address) <br /> Street No. Direction Street Name StreetT e A t/Bld Suite <br /> CITY(23) E I STATE(24) El ZIP(25) <br /> Primary IV. EMERGENCY CONTACTS Secondary <br /> NAME(26) MARK RUTLEDGE NAME(3 1) BRUCE RUSKIN <br /> TITLE(27) IGEN MGR TITLE(32) ASST MGR <br /> BUSINESS PHONE(28) 209-473-2420 BUSINESS PHONE(33) 209-473-2420 <br /> 24-HOUR PHONE(29) 209-941-9731 24-HOUR PHONE(34) 209-557-0600 <br /> PAGER#(30) CELL 209-815-1080 PAGER#(35) 209-606-0272 <br /> EXTREMELY HAZARDOUS SUBSTANCES (EHS) <br /> ON-SITE EHS (36) NO If yes,and above Threshold Planning Quantities,attach a sheet of paper with a general <br /> description of the process and principle equipment involving the EHS. <br /> ADDITIONAL LOCALLY COLLECTED INFORMATION(37) Provide information requested on the back of this form <br /> NAME OF DOCUMENT PREPARER(38) KATHY SHAVER, LICENSE ADMINISTRATOR <br /> NAME OF OWNER/OPERATOR(39) GMRI INC DATE(40) <br /> DATE REC'D: 12/3/04 <br />