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:TATE OF CALIFORNIA � -. _ - - GOVERNOR'S OFFICE OF EMERGENCY SERVICES <br /> 1ALIFORNIA ACCIDENTAL RELEA=SE PREVENTION <br /> ')ROGRAM REGISTRATION �y } <br /> )ES 2735.6(NEW 6197) OCT -. 6 1y+.ff PAGE 1 OF 1 <br /> REGISTRATION TYPE UPDATE TYPE <br /> i <br /> 'instructions on reverse before completing, 0 NEW ❑ UPDATE ❑ ADD ❑ DELETE ❑ REVISE <br /> . Business Owner/Operator Information <br /> BUSINESS NAME <br /> George Reed, Inc, (Clements) <br /> ADDRESS (Number and Street) <br /> 17300 Jahant Road <br /> CITY COUNTY STATE ZIP CODE <br /> Clements San Joaquin CA 95227__ <br /> CWNERtOPERATOR NAME .PHONE NUMBER <br /> Jack Gingrich (209) 759-3331 <br /> 11. Regulated Substance List <br /> A. Game of Each Regulated Substance Process Max. CAS# <br /> - Quantity(lbs) I—. - <br /> 1 Liquified Petroleum Gas 70479 . 351 74-98-6 <br /> 2. <br /> 3. <br /> 4. <br /> 5. <br /> 6.- <br /> 7 <br /> 3. <br /> B. Name of Each Regulated Substance in a Mixture Percent Process Max. CAS# <br /> g Weight Quantity(lbs) <br /> I. <br /> Ill. Certification <br /> 1, 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 /> ti this certification, executed on the date indicated below, is made under penalty of perjury under the laws of the <br /> Srme of California. <br /> OWNERIOPERATOR NAME(PAINT) <br /> Jack Gingri h <br /> OWNERIOPERATOR SIGN RE DATE EXECUTED <br /> 10-03-97 <br />