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-ATE CF CALIFORNIA �...._ GOVERNOR'S OFFICE OF EMERGENCY SERVIC S <br /> "ALIFORNIA ACCIDENTAL RELEASE PREVENTION <br /> '3ROGRAM REGISTRATION <br /> ?ES 2735.6(NEW 6/97) OCT — 11997 I PAGE OF <br /> REGISTRATION TYPE UPDATE TYPE <br /> instructions on reverse before_completing. ! NEW 2 UPDATE ❑ ADD ❑ DELETE z REVISE <br /> Business Owner/Operat"I l formation: _ <br /> BUSINESS NAME <br /> S A-fZ ?,LrZL�>—r r Sljg? `7 <br /> ADDRESS (NuftsrwCSf t) <br /> 171 C) I BRMlC�> <br /> CITY COUNTY STATE LP CODE <br /> LO c t� Fo12� I 0-Y—L C4 al 57 <br /> 2 <br /> 3 7� <br /> OWNEP/OPERAIOT V� f3��=N� ySTdt - � PHONE NMEE 2-7- 5�0 <br /> II. Regulated Substance List <br /> . <br /> A. Name of Each Regulated Substance QuantProcessity(lbsMax) CAS# <br /> 2. 3s1J37 <br /> 3. <br /> 4. <br /> 5. <br /> 0%, <br /> 7. <br /> 8. <br /> B. Name of Each Regulated Substance in a Mixture Percent Process Max. CAS# <br /> Weight Quantity(Ibs) <br /> 1. <br /> 2. <br /> III. Certification <br /> 1, 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. 1 am fully aware <br /> thr� *his certification, executed on the date indicated below, is made under penalty of perjury under the laws of the <br /> Stl�„of California. <br /> OWNEIWPERATOR NAME(PRINT) <br /> OWNEW/OPERATOR SIGNATOR DATE Ex UTED <br />