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STATE OF CALIFORNIA <br /> CALIFORNIA ACCIDENTAL REI ASE PREVENTION G^VERNOR'S OFFICE OF EMERGENCY SERVICES <br /> PROGRAM REGISTRATION <br /> OES 2735.6(NEW 6/97) <br /> [Ll%` SEP 2 91MPAGE I OF_I <br /> Read instructions on revers1heAgre completing R©T NEW NTYPE UPDATE UPDATE TYPE <br /> ADD ❑ DELETE ❑ REVISE <br /> I. Busyness Owner/Operator Information <br /> BUSINESS NAME <br /> Western Farm Service, Inc. <br /> ADDRESS (Number and$(rest) <br /> 1905 n. BPoadway Ave. <br /> CITY <br /> Stockton COUNTY STATE ZIP CODE <br /> San Joaquin Ca 95205 <br /> OWNER/OPERATOR NAME <br /> R.C. Mercer, Manager PHONE NUMBER <br /> (209)547-2600 <br /> II. Regulated Substance List <br /> A. Name of Each Regulated Substance Process Max, <br /> (lbs) CAS# <br /> I. Ammonia (anhydrous) 60,000 7664-41-7 <br /> z. Ammonia (conc. 20% or greater) 180,000 7664-41-7 <br /> 3. Disulfoton (Disyston 8) 3600 298-04-4 <br /> q Phorate (thimet) 25000 298-02-2 <br /> 5 Azinphos-Methyl (Guthion) 540 86-50-0 <br /> 6 Methomyl 800 16752-77-5 <br /> 7. Methyl Parathion 10800 298-00-0 <br /> s. <br /> B. Name of Each Regulated Substance in a Mixture Percent Process Max.Weight Quantity(lbs) CAS# <br /> I. <br /> 2. <br /> III. Certification <br /> I, the owner or operator of the aforementioned business, hereby certify that the registration information provided <br /> above is true, accurate, and complete to the best of my knowledge, based upon reasonable inquiry. I am fully aware <br /> that this certification, executed on the date indicated below, is made under penalty of perjury under the laws of the <br /> State of California. <br /> OWNEiWPERATOR NAME(PRINT) <br /> C. Mercer Manager <br /> O E R SI E DATE EXECUTED <br /> 0 09/29/97 <br />