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Alk <br /> BUSINESS OWNER/OPE TOR IDENTIFICATION FORM SIDE 2 <br /> BUSINESS MAILING AND BILLING INFORMATION <br /> ORMATION <br /> MAILING ADDRESS(41) ) �� ------ -- O. <br /> T1-- <br /> (If dif��ft8rtiSi�t�dress 30 <br /> NOTE: All time sensitive and Street No. Direction Street Name Street Type <br /> official correspondence will S9 <br /> be sent to this address Or ndo 3 3 0 <br /> Y STATE ZIP <br /> BILLING ADDRESS(42) apt <br /> If different from above, Same IAN 16 20V <br /> include"Care of info ion <br /> c O• l 93 <br /> GL- Azs SR — 3o nFracC.:. _. .. ._ <br /> ADDITIONAL BUSINESS INFORMATION <br /> TYPE OF FaCorporation <br /> Single Owner E]Partnership UNSTAFFED SITE NETWORK(44) YES X❑NO <br /> ORGANIZATION (43) ❑Public Agency <br /> ASSESSOR PARCEL NO. (45) (111222023 <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 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) IF YES, <br /> LOCK BOX ❑YES QX NO 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)r� <br /> names and signatures of employees trained,and names of instructor(s)? ILQ_YES �X NO <br /> 12/00 <br />