Laserfiche WebLink
SECTION I ' <br /> NOTIFICATION <br /> BUSINESS NAME "v=- .)Px- �tF�czA �A �zsof�nn IORP <br /> FACILITY STREET ADDRESS W C+4uQc � <br /> CITY cc?Co*) ZIP 9 52D3 <br /> FACILITY TELEPHONE( 7-04 ) 4.6&-525 1 <br /> MAILING ADDRESS F 00 UJ CyacuS� <br /> CITY S-CO Ic-Co.J, LA-1 _ZIP gg203 <br /> TELEPHONE ( 2o9 ) 4h6-525 1 <br /> (If diffemm from Company Hradqua m) <br /> J <br /> LOCAL PRIMARY BUSINESS EMERGENCY CONTACT <br /> NAME S� p�UC r <br /> RESIDENCE 9 a 6 n TRF u•roJ W" �r n Y_= • S C5 Z1ZZ <br /> TELEPHONE(OFFICE)( io9 ) 4166-525 I (HOME)( <br /> LOCAL ALTERNATE BUSINESS EMERGENCY CONTACT <br /> NAME 1 T;_ <br /> RESIDENCE 9 37 LRArv- CA%J-i01J AV sw1VE� Ta T E <br /> TELEPHONE(OFFICE)( ZCR ) 4-G6-5Z� I ( <br /> 24-HOUR ON-SITE CONTACT TELEPHONE ( ) <br /> (If Availablc) <br /> 1 declare under the penalty of perjury that I have reviewed this entire Hazardous Materials Manage- <br /> ment Plan and it is accurate to the best of my knowledge. 1 understand that false/inaccurate infor- <br /> mation may contribute to complications during a hazardous material incident. This declaration is <br /> made in the City of --)-ToC,I.L;ro & — California- <br /> NAME OF ON-SITE <br /> alifornia- <br /> NAMEOFON-SITE MANAGER om-%<f)C•\/�ILt/NCE UT Tm-E `-sEVE¢k�MR�R6FR <br /> SIGNATUREOFON-SITEMANAGER C �'7 �C V ./'" DATE <br /> NAMEOFPERSON 'ITLE'PSRSDD's_`,p'u;"��L <br /> Responsible for the completion of HMMP mww <br /> SIGNATURE / F+ �(SA�u IPJ DATE IZ-7-3-q3 <br /> 2 <br /> .w. <br />