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#TATE OF CALIFORNIA r^` ERNOR'S OFFICE OF EMERGENCY SERVICES <br />CALIFORNIA ACCIDENTAL RSF PREVENTION <br />PROGRAM REGISTRATION <br />OES 2735.6 (NEW 6/97) w�'�' PAGE 1 OF <br />.REGISTRATION TYPE UPDATE TYPE <br />Wad instructions on reverse before completing.197 NEW 11 UPDATE 1:1 ADD 1:1 DEUM E] REVISE <br />w. Business Owner/Operator Information <br />BUSINESS NAME <br />AME,zcer� <br />ADDRESS (Numbermc Slreel) <br />X3455 U E D 1 u w y C19 Ealep- a 1w' <br />CITY C (� COUNTY STATE ZIP CODE <br />II. Requlated Substance List <br />A. <br />Name of Each Regulated Substance <br />Process Max. <br />Quantity (Ibs) <br />CAS# <br />t. <br />85000 <br />-14`16-(a <br />2. <br />3. <br />4. <br />5. <br />6. <br />7. <br />8. <br />B. <br />Name of Each Regulated Substance in a Mixture <br />Percent <br />Weight <br />Process Max. <br />Quantity (Ibs) <br />CAS# <br />t. <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 />that this certification, executed on the date indicated below, is made under penalty of perjury under the laws of the <br />State of California. <br />