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ATE OF CALIFORNIA LS GOVERNOR'S OFFICE OF EMERGENCY SERVICES <br /> 3ALIFORNIA ACCIDENTAL RELEASE PREVENTION <br /> pRbGRAM REGISTRATION SEPI C6 �� <br /> OES 2735.6(NEW 6/97) 8 1997 PAGE OF <br /> REGIS TYPE UPDATETYPE <br /> d instructions on reverse before completing. NEW UPDATE ADD [:] DELETE ❑ REVISE <br /> ,. Business Owner/Operator Information <br /> BUSINESS NAME <br /> ADD R SS (Nu randstreet) fj , <br /> TY CO STATE ZIPCODE <br /> 0 ERIOPERATOR NA PHONE NUMBER <br /> II. Regulated Substance List <br /> Process Max. CAS# <br /> A. Name of Each Regulated Substance Quantity(Ibs) <br /> t. . <br /> 2. <br /> 3. <br /> 4. <br /> i <br /> 7. <br /> 8. <br /> B. Name of Each Regulated Substance in a Mixture Percent Process Max. CAS#Weight Quantity(Ibs) <br /> t•� L z .5 °a 300 <br /> i <br /> 2. <br /> III. 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. 1 am fully aware <br /> i' this certification, executed on the date indicated below, is made under penalty of perjury under the laws of the <br /> J? fe of California. <br /> OWNER/OPERATO AME(PRINT) <br /> OWNE P gANATGRE DATE CUTED <br /> r <br /> s - <br />