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;TATE OF CALIFORNIA GOVERNOR'S OFFICE OF EMERGENCY SERVICES <br /> ALIFORNIA ACCIDENTAL RELEASE-PREVENTION <br /> GROGRAM REGISTRATION <br /> OES 2795.6(NEW 6197) _ PAGE OF Z <br /> =*I 1199 r REGISTRATION TYPE UPDATE TYPE <br /> i instructions on reverse before completing. ® NEW ❑ LIPOATE ❑ ADD ❑ DELETE ❑ REVISE <br /> 1. Business Owner/Operator InformatI6W,'PnYs, <br /> BUSINESS NAME rnrn (� <br /> 5 ( GMF} �t 12Ntd ms �/�. I S12S�K7�/ D( VISt� MPH A/ SITC- <br /> ADDRESS (NumberwdSh t) I �`� <br /> 19 40 Lu. C K04kt I � -3 Tt i <br /> CITY COUNTYSTATE 21P CODS <br /> U t w/ C.,4- 103 <br /> OWNER/OPERATOR NAME _A ' <br /> SAe K \l o i7 7�5�1,V PNONE NUMBER <br /> acxr-q661 -yCWD <br /> II. Regulated Substance List <br /> A. Name of Each Regulated Substance Process Max. CAS# <br /> Quantity(lbs) <br /> 1. e 70 9 ID 707-37-2- <br /> 2. <br /> 07-3722. �v L-f Llk ce (h-c u `l66 q(w <br /> 3. <br /> 4. <br /> 5. <br /> 6\+ <br /> 7. <br /> 8. <br /> B. Name of Each Regulated Substance in a Mixture Percent Process Max. CAS# <br /> g Weight Quantity(Ibs) <br /> fUt tC ( C7 ( M ?G9 37 Z <br /> 2. S z���u R �� -D T C"� ( 3 GGtr-q3 9 <br /> avo -R tyu ep a-)v Pta Z <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 /> th his certification, executed on the date indicated below, is made under penalty of perjury under the laws of the <br /> Slsw of California. <br /> OWNERIOPERATOR NAME(PRINT) <br /> SO wScm) <br /> OWNER/OPE OR SIG A GATE E%ECUTED <br /> g/2 <br />