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STATE OF CALIFORNIA �ERNOR'S OFFICE OF EMERGENCY SERVICES <br /> CALIFORNIA ACCIDENTAL REUSE PREVENTION <br /> PROGRAM REGISTRATION <br /> OES 2735.6(NEW 6/97) PAGE 1 OF 1 <br /> REGISTRATION TYPE UPDATE TYPE <br /> read instructions on reverse before completing. 9 NEW El UPDATE El ADD ❑ DELETE ❑ REVISE <br /> Business Owner/Operator Information <br /> BUSINESS NAME <br /> CALIFORNIA CONCENTRATE COMPANY <br /> 4DDRESS (NumberWd SEMI) <br /> 18678 N. HIGHWAY 99 _ <br /> CITY COUNTY STATE ZIP CODE <br /> ACAMPO SAN JOAQUIN CA 95220 <br /> OWNER/OPERATOR NAME PHONE NUMBER <br /> DENNIS P. ALEXANDER (209) 334-9112 <br /> 11. Regulated Substance List <br /> Process Max. <br /> A. Name of Each Regulated Substance Quantity(Ibs) CAS# <br /> I. ANHYDROUS AMMONIA 9 , 640 lb. 7664-41-7 <br /> 2. SULFUR DIOXIDE 2, 100- 1b. 7446-09-5 <br /> 3. <br /> 4. <br /> 5. <br /> 6. <br /> 7. <br /> S. <br /> S. Name of Each Re ulated Substance in a Mixture Percent Process Max. CAS# <br /> 9 Weight Quantity(lbs) <br /> 1. • <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 /> that this certification, executed on the date indicated below, is made under penalty of perjury under the laws of the <br /> State of CaliforniaD�VOS P (-l�,,17VDER <br /> OWNER/OPERATOR NAME(PRINT) <br /> DENNIS P. A ER <br /> OWNER/OPERATOR SIGNATOR GATE EXECUTED <br /> � 9-22-97 <br />