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STATE OF CALIFORNIA GOVERNOR'S OFFICE OF EMERGENCY SERVICES <br /> -�ALJFORNIA ACCIDENTA ECE�- i N <br /> PROGRAM REGISTRATIO Is <br /> SES 2735.6(NEW 6/97) # [�] PAGE OF <br /> f ° SEP — 2 X9'07 REGISTRATION TYPE U <br /> PDATE <br /> instructions on reverse before completing. � NEW � UPDATE � � DELETE REVISE <br /> Business Owner/Operator Information <br /> 3USINESS NAME <br /> I oAeAy S'ch oaJ <br /> ADDRESS (NumberandStreet) <br /> • tL <br /> CITY COUNTY STATE ZIP CODE <br /> OWNER/OPERATOR NAME — PHONE NUMBER <br /> 1<� c Sc�,e-e 20 S -3-31- ?99 <br /> 11. Regulated Substance List <br /> A. Mame of Each Regulated Substance Process Max. <br /> Quantity(Ibs) OAS# <br /> L Argon I 1.000 7440-37-1 <br /> 2. OxYg en 11000 7782-44-7 <br /> Acetylene Gas 1,000 74-86-2 <br /> 4. <br /> 5. <br /> 6. <br /> 7. <br /> 8. <br /> Percent Process Max. <br /> B. Name of Each Regulated Substance in a Mixture Weight Quantity(Ibs) P 'OAS# <br /> I. Calcium Hypochlorite 65% 300 7778-54-3 <br /> Inert Ingredients 35% <br /> 2. <br /> 111. 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 /> th"' 'ais certification, executed on the date indicated below, is made under penalty of perjury under the laws of the <br /> State of California. <br /> OWNERIOPERATOR NAME(PAINT) <br /> 1 a Lam,cf .Sc1 <br /> �N _� OR 60kel$IGN k i') <br /> yJ E DATE EXECUTED <br /> 7 -R <br />