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BUSINESS IDENTIFICATION FORM Page 2 of 3 <br /> NAME OF DOCUMENT PREPARER (38) GRACE E HAGGARD <br /> NAME OF OWNER/OPERATOR 39 ROB ROBISON DATE 40 11/07/2007 <br /> BUSINESS MAILING AND BILLING INFORMATION <br /> MAILING ADDRESS (41) <br /> (If different from Site Address(6),otherwise leave blank.) <br /> NOTE:ALL TIME SENSITIVE AND OFFICIAL CORRESPONDENCE WILL BE SENT TO THIS ADDRESS <br /> 4000 LUXOTTICA AVE <br /> STREET NUMBER DIRECTION STREET NAME STREET TYPE STE/APPT/BLDG <br /> MASON OH 45040 <br /> CITY STATE ZIP <br /> BILLING ADDRESS (42) <br /> (If different from Mailing Address(41),otherwise leave blank.) <br /> NOTE:INCLUDE"CARE OF"INFORMATION <br /> STREET NUMBER DIRECTION STREET NAME STREET TYPE STE/APPT/BLDG <br /> CITY STATE ZIP <br /> ADDITIONAL BUSINESS INFORMATION <br /> PE OF C Single Owner C Corporation C Partnership C Public Agency <br /> ORGANIZATION (43) <br /> UNSTAFFED SITE <br /> NETWORK (44) <br /> ASSESSOR PARCEL NO. (45) <br /> PROPERTY OWNER GLIMCHER REALITY TRUST PHONE NO. (47) 614-621-0000 <br /> NAME (45) <br /> PROPERTY OWNER 150 E GAY ST <br /> ADDRESS (48) <br /> STREET ADDRESS <br /> COLUMBUS OH 43215 <br /> CITY STATE ZIP <br /> FIRE DISTRICT(49) FIRE DISTRICT # <br /> NEAREST CROSS <br /> STREET(50) <br /> FACILITY IF YES, <br /> LOCK BOX (51) WHERE IS IT LOCATED? (52) <br /> NATURE OF BUSINESS (53) OPTICAL RETAIL <br /> WASTE GENERATOR (54) IF YES, <br /> WHAT IS YOUR EPA <br /> http://sjoesdata.org/oes hmmp/section_tables/CHMIRF_ps_review.lasso?-Database=transa... 8/9/2010 <br />