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Fold I 1 ' '' i <br />61 9,t f <br />m <br />BUSINESS NAME Mountain Valley Express Co. Inc. <br />FACILITY STREET ADDRESS 1019 Bessemer Ave, <br />CITY Manteca ZIP 9533' <br />FACILITY TELEPHONE (20 9) 823-2168 <br />MAILING1 tP.O. <br />'CE° t• .: <br />LOCAL1EMERGENCY <br />NAME arlie Giles <br />RESIDENCE 7899 Koftow. Ct. Manteca Ca. 95336 <br />TELEPHONF- (office) 209-8232168 (home ) 209-.8235452 <br />LOCAL BUSINESS f <br />NAME Charles flarman <br />ADDRESS 839 Nordic Ave Manteca Ca. 95336 <br />TELEPHONE- iii 1• • home t <br />I declare under the penalty ofperjury that I have reviewed this entire Hazardous <br />Materials Manngement plan and it is accurate to the best of my knowledge. I <br />during a hazardous material incident. That declaration is made in the city of <br />MantecaCalifornia. <br />NAME OF PERSON Charles Harman TITLE Maint• Manager <br />Responsible for the completion of HN1W <br />SIGNATURE. <br />