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':"ATECFCALIFORNIA GOVERNOR'S OFFICE OF EMERGENCY SERVICES <br /> ",LIFORNIAACCIDENTAL RELEASE PREVENTION <br /> ROGRAM REGISTRATION. ; <br /> )ES 2735.6(NEW 6/97) ' ' PAGE OF <br /> 199 I REGISTRATION TYPE ���,,,III UPDATE TYPE <br /> :? a instructions on reverse before completing. NEW UPDATE ❑ ADO ❑ DELETE REVISE <br /> '�Tusiness Owner/Operator Information <br /> :USINESS NAME <br /> S I A-fZ �5 <br /> ADDRESS (NumMrwd Str fj <br /> n F , BR N� <br /> g;Ty COUNTY STATE ZIP CODE <br /> LO CKrf.Fv(27 j C4 d/ 5 2, <br /> OMEPIOPER50R NAME PHONE NUMBER <br /> SrAvZ (QyzlJ� Tsl(r `�yST/ S ZD�i � Z� 5504 <br /> II. Regulated Substance List <br /> Process Max. <br /> A. Name of Each Regulated Substance Quantity(Ibs) CAS# <br /> I_ ;. 2 , Qfa�. c�� 4.-9 9-6, <br /> tLJX_AA> )" <br /> 3. <br /> 5. <br /> 6.A. <br /> 7. <br /> 3. �I <br /> Regulated Substance in a Mixture Percent Process Max. CAS# <br /> B. Name of Each Re <br /> 9 Weight Quantity(Ibs) <br /> 1. <br /> 2. <br /> III. Certification <br /> I, the owner or operator of the aforementioned business, hereby certify that the registration information provided <br /> above is true, accurate, and complete to the best of my knowledge, based upon reasonable inquiry. I am fully aware <br /> the 'is certification, executed on the date indicated below, is made under penalty of perjury under the laws of the <br /> Stahl f California. <br /> OWNERIOPERATOR NAME(PRIIN77 <br /> OMERIOPERATOR SIGNATUR DATE E% UTEO <br />