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TATE OF CALIFORNIA GOVERNOR'S OFFICE OF EMERGENCY SERVICES <br /> =FORNIA AC IDE L E-PREVENTION <br /> 'ROGRAM REGISTR _. <br /> is 2735.6(NEW 6)97) PAGE Z OF <br /> WT _ igg <br /> REGISTRATION TYPE UPDATETYPE <br /> _ instructions on reverse before comPIFE,g. I X I NEW a UPDATE ❑ ADD DELETE ❑ REVISE <br /> Business Owner/Operator Information H <br /> BUSINESS NAME I\/"S e- <br /> ' <br /> ADDRESS (NumbWWd S~) <br /> CITY COUNTY STATE ZIP CODE <br /> OWNERADPERATOR NAME PHONE NUMBER <br /> 11. Regulated Substance List <br /> Regulated Substance Process Max. <br /> A. Name of Each Re <br /> 9 Quantify(lbs) CAS# <br /> i <br /> 2. <br /> 3. <br /> 4. <br /> 5. <br /> 6. <br /> 7. <br /> 8. <br /> Percent ProcessMax. CAS# <br /> B. Name of Each Regulated Substance in a Mixture C.rUt\/"C"/l�/u e7D> Weight Quantity(Ibs) <br /> I s-r ( ISD <br /> I -r <br /> 1-C VD <br /> 2. .20 &- <br /> L{o YaD <br /> SD SuD <br /> Ill. Certification <br /> 1, the owner or operator of the aforementioned business, hereby certify that the registration information provided <br /> ab--•q is true, accurate, and complete to the best of my knowledge, based upon reasonable inquiry. I am fully aware <br /> thl#. i is certification, executed on the date indicated below, is made under penalty of perjury under the laws of the <br /> State of California. <br /> OWNERIOPERATOR NAME(PRINT) <br /> 74\C OI-j S'oy <br /> EFVOPERATOB51jiNAy,taE , D9z /E <br />