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S4N JOVIOUinr Cwnrr <br />OFFICE OF EMERGENCY SERVICES <br />-- WARDLIUS MATERIALS RSA - <br />PLEASE PRINT OR TYPE <br />01. Please provi•le your full and complete business name i0dress. <br />Business 'dam? '/!.0 ✓ lOd �5 <br />Mailing Address Y 4k 92 '9174; <br />City, State, 7:1p <br />Telephone Numher <br />Contac, 'ersc� —f <br />Q2. Ooes/Will your business handle, store, or transport hmsrdous materials? <br />res. G No <br />NOTE: Hazardous materials are defined as any meterial that, because +f <br />of its quantity, concentration, or physical or chsisical characteristiggq <br />poses a 'Aoni.f!can•. rresent or potential hazard to human health and <br />safety o:'i.o .ha a v.ronrwnt if released into the workplace or the <br />environment. "daz;irrious materials" include, but ee not limited to <br />such sunstances rs, n soline. dzese , motor of , c0_ vents, propane. <br />03. If you answered "Yt,S" 'o Cluestlon No. 2 above: <br />0o you nanuie, store, or transport more than 55 gallons, 500 pounds, or 200 <br />cubic feet (STP)o of a product or formulation containing hazardous materials <br />at any one time in a month? <br />No <br />"Standard Temperature or Pressure <br />Name of Owner/Flepresentat <br />If you have any questions regarding this survey, please call the Office of <br />Services at 944-2115. <br />