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Tier Two Emergency and Hazardous Chemical Inventory 1rt11sC�`= � � �'�' <br /> Reporting Period From January 1 to December 31, 2005 ' Page t_ of 2 <br /> LUVU <br /> Facility Identification Owner/Operator Name <br /> Noma Flying J Travel Plaza Name CFJ Properties ENVIE30i'diu0i' A! <br /> Stred 1501 N.Jack Tone Rd Mail 1104 Country Hill Dr <br /> PER��IITISERVICES�t IVB' <br /> MAR -9 <br /> city Ripon county San Joaquin stats CA ap 95366 Cly Ogden SAX JUAUuin���,�,y <br /> OF i E OF EMERGENCY SER1/,C 4 <br /> Latitude Longibrde country USA -'Stm .UT ap 84403 'Gauntly .US� <br /> Mailing Address (if different from facility address) Emergency Contact <br /> street 1104 Country Hili Dr 'Nahie .' John Bogue Me .District Manager <br /> city Ogden state UT ap 84403 country USA Phone. 208-385-9745 24 Hr.Phone'� 801710-8128 <br /> :Name: Jose Jimenez TitleGeneral-Manager <br /> SIC code 5541 Dun a Brad Number 623404449 <br /> Phone 209-599-4141 24 Hr.Phone- <br /> 8 <br /> Physical and -• g' Storage Codes;and.Locations <br /> Chemical Description Heath Hazards Inventory . (Non-Confidential) <br /> ❑ Check If all of the Information for thts chemical is ® Q6 B 1 4 <br /> identical to the Information submitted last year Fite <br /> Max:Daly <br /> C" 68476-34-6 Trade Secret ❑ ❑ Pre nsof s�RrRe�ease Amount(code) <br /> Diesel re <br /> E] R An.Da°ly <br /> Name ® Immediate(scuta) Amount(coda) <br /> Cheek All ❑ ® ❑ ® ❑ ❑ ® (chronic} �� <br /> That Appy Pura Milt Solid U uld Gas ENS On-aft(days) <br /> ❑ m <br /> Check rfo°h"eI O1��'$l1re��1� ® 05 B 1 4 <br /> identica! the Irrmatlon submitted tact year Are <br /> tAa1r.Daily GAS 8006-61-9 Trade stare( ❑ ❑ Sudden Release Amount(cods) <br /> Of P. To <br /> Gasoline ❑ ""h" Ar°DaIn, <br /> Nanta ® Immediate(acute) Amount(code) <br /> ® Delayed(chronic) 365 <br /> Check Ali ❑ ® El ® El No.No.of Days I <br /> That Apply Pure Mix Solid Liquid 0135 EHS On-sm Ids) <br /> Certification(Read and sign after completing all sections) Optional Attchmsnts ; <br /> I certify under penalty of law that I have personalty examined and am famillarwith the information submitted in pages one through 2. ❑ 1 have attached a site pian <br /> and that basad on my Inquiry of those Individuals responsible far obtaining this Informatlon,t believe thatthe submitted Information Is trot accurate,and complain. <br /> Paul Siler �_ ��2/®� El 1 have attar:had 31tst of alts eoorellnaba abbreviations <br /> ❑ <br /> I have attached a description or dikes and other <br /> Name and official Me of awnerloperalnr gignalub Date signed safeguards measures <br /> OR a nterlopereeors authorized represwitative <br />