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Li JAN 12 <br /> 1999 <br /> 'QUIN COUNTY OF SAN JOAQUIN <br /> ZO. .CQ <br /> OFFICE OF EMERGENCY SERVICES RONALD E.BALDWIN <br /> < a ROOM 610,COURTHOUSE COORDINATOR <br /> 222 EAST WEBER AVENUE <br /> STOCKTON,CALIFORNIA 95202 <br /> TELEPHONE468-3962 <br /> HAZARDOUS MATERIALSDIVISION <br /> _..- <br /> (209)468-3969 L5 6 U l5 D <br /> 8 <br /> CARBON DIOXIDE DISCLOSURE SURVEY E, 2199 <br /> JO�QtN <br /> OFFICEOF EMOi6p1N1Y <br /> Please read the information on the reverse side before completing this survey form. A separate survey for each business name <br /> and/or address in San Joaquin County is required. <br /> Business Name Red Lobster #381 <br /> Business Owner(s)Name GMRI Inc. Telephone 407/245-5398 <br /> Business Address 3780 Sports Arena Blvd. , San Diego, CA 92110 <br /> Mailing Address(if different from above) c/o GMRI, Inc. , P. 0. Box 593330, Orlando, FL 32859-3330 <br /> Nature of Business Seafood Restaurant Fire District <br /> Ql. 9 Yes ❑ No Does your business handle Carbon Dioxide(CO2)in any quantity at any one time during the year? <br /> Q2. ❑' Yes 91 No Does your business handle Carbon Dioxide(CO2)in a quantity equal to or greater than 1,200 cubic feet <br /> or 137 pounds at any one time during the year? <br /> I have read the information on this form and understand my requirements under Chapter 6.95 of the California Health and Safety <br /> Code. I understand that if I own a facility or property that is used by tenants,that it is my responsibility to notify the tenants of <br /> the requirements which must be met prior to issuance of a Certificate of Occupancy or beginning of operations. I declare under the <br /> penalty of perjury that the information provided on this disclosure survey is true and accurate to the best of my knowledge. <br /> Owner or Authorized Agent: <br /> GMRI, Inc. <br /> X By: E. Charlene Fauley, Asst. Secretary Date 11/6/98 <br /> Print Name <br /> X Title <br /> Signature <br /> (9/98) <br />