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r] <br />RE GISTRATIONFOR 1+ <br />1r. • <br />GENERATOR <br />• <br />City State Zip <br />Phone Number( . <br />GENERATOR DD. <br />City State . zip <br />TYPE OF <br />AUTHORIZED <br />EMERGENCY PHONE <br />REGISTRATION FOR.- <br />(Check <br />OR:(Check One) <br />Small Quantity Generator With • 00 <br />Large Quantity Only. (Generates 200 or more <br />LargeQuantity GeneratorOnsite Treatment.(Generates 1 i or • r • <br />declare underpenalty of r the best of • t• and beliefen <br />• • • -r • • - inspections .• <br />pursuant to the California• • incidental to the issuan <br />of this registration and the operation of this business. <br />SIGNATURE: E: ,—DATE: <br />y <br />