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k x <br />BUSINESS NAME <br />(} qq� ECTION 1 <br />NOTIFICATION <br />L 2 3 AM 11: <br />!),a2IM s <br />FACILITY STREET ADDRESS L-3 3 C c\) V \ L -r zl � <br />CITY �-� ZIP a , )-4 TELEPHONE (2J a) 3 (,Q_ "1 <br />MAILING ADDRESS �lo\o W `ZA 7 G CLCD <br />CITY ZIP `)5 a - <br />BILLING ADDRESS 1 b�0 %1P" K� CM t <br />CITY ZIP 01 ,:�- <br />(If different from mailing address) <br />TELEPHONE( '�)LA \ <br />TELEPHONE (2 C� ) CH `b - `i 41-1 <br />14� <br />NAME OF PERSON RESPONSIBLE FOR THE ItOMPLETION0 HMMP mtuNm <br />MAILING ADDRESS , (Db w eS CI r <br />CITY ZIP TELEPHONE (_� g) c) k T -' c 4Lj , k <br />(If different from facility mailing address) <br />LOCAL PRIMARY BUSINESS EMERGENCY CONTACT <br />NAME D\RN Ecc�►J <br />RESIDENCE <br />TELEPHONE (OFFICE) (?r9) (HOME) (_2_Z)'-) 333 — J Z3 <br />LOCAL ALTERNATE BUSINESS EMERGENCY CONTACT <br />NAME L 1\iC1y.i CiLv !"� <br />RESIDENCE 3� Z- 1X475 \v STvLiC�,- 9 Z� <br />TELEPHONE (OFFICE) (2 ) LA (HOME) <br />24-HOUR ON-SITE CONTACT <br />(If Available) <br />TELEPHONE ( <br />413— 'K_13\. <br />I declare under the penalty of perjury that I have reviewed this entire Hazardous Materials Management Plan and it <br />is accurate to the best of my knowledge under the laws of the State of California. I understand that false/inaccurate <br />information may contribute to complications during a hazardous material incident. This declaration is made in the <br />City0f i o c tl *.1 California. S �= rte? i 1�J o L� z 'Z))\- 1"4 ) <br />TITLE �v Pt- C nl C MQ an 1i2 C� <br />NAME OF FACILITY MANAGER/_77ER (PtuNr) <br />SIGNATURE <br />I <br />1996 <br />