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r , <br /> BUSINESS OWNER/OPERATOR IDENTIFICATION FORM SIDE 2 <br /> BUSINESS MAILING AND BILLING INFORMATION <br /> erent m i e <br /> ` * dresi� s) 1751 � Directors Row <br /> (l T` <br /> NOTE: All time sensitive and Street No. Direction Street Name Street Type <br /> official correspondence will <br /> be sent to this address Orlando 32809 <br /> CITY STATE ZIP <br /> BILUNG ADDRESS(42) � �Y► 121 r lx%C 2J <br /> If different from above, Same ?Jtase- U (�A o <br /> include"Care of information u <br /> L r Iando l FL 312 <br /> ADDITIONAL BUSINESS INFORMATION <br /> TYPE OF ❑Single Owner ❑Partnership UNSTAFFED SITE NETWORK(44) ❑yES QNO <br /> ORGANIZATION (43) PCorporation ❑Public Agency <br /> ASSESSOR PARCEL NO. (45) ()11222023 <br /> PROPERTY OWNER (46) PHONE NO.(47) 407/245-4000 <br /> NAME GMRI, Inc. <br /> (If different from Business Owner) <br /> PROPERTY OWNER (48) <br /> ADDRESS P. 0. Box 593330 <br /> Street Address <br /> Orlando r-FL 32859-3330 <br /> CITY STATE ZIP <br /> FIRE DISTRICT (49) <br /> City of Stockton <br /> NEAREST CROSS (50) <br /> STREET Quail Lakes <br /> FACILITY (51) ❑yES QX NO IF YES, <br /> LOCK BOX WHERE IS IT LOCATED?(52) <br /> NATURE OF BUSINESS (53) <br /> Full Service Seafood Restaurant <br /> WASTE GENERATOR (54) IF YES, <br /> ❑YES ®NO WHAT IS YOUR EPA NO.?(55) <br /> TRADE SECRET (56) ��SPILL PREVENTION (57) <br /> INFORMATION AND COUNTERMEASURES <br /> 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 ®NO <br /> Does your business maintain written training records that show the training subject,date(s)of training, (59)�� <br /> names and signatures of employees trained,and names of instructor(s)? YES QX NO <br /> 12100 <br />