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STATE OF CALIFORNIA GOVERNOR'S OFFICE OF EMERGENCY SERVICES' <br /> CALIFORNIA ACCIDENTAL RELPE PREVENTION <br /> PROGRAM REGISTRATION <br /> OES 2735.8(NEW 6197) PAGE_&_ <br /> lyl(;I -• ZI& REGISTRATION TYPE UPDATETYPE <br /> Read instructions on reverse before completing. NEW ® UPDATE ® ADD E] DELETE ❑ REVISE <br /> I. Business Owner/Operator Information <br /> BUSINESS NAME <br /> STOCKTON FURTHER PROCESSIMG <br /> ADDRESS (Numbdrad&t t) <br /> 414 High Street <br /> CITY COUNTY STATE LP CODE <br /> Modesto San Joaquin Ca . 95206-1125 <br /> OWNERCPERATOR NAME PHONE NUMBER <br /> Ed Garrett 948-0129 <br /> II. Regulated Substance List <br /> A. Name of Each Regulated Substance Process Max.Quantity Quantity(lbs) <br /> 1- Anhydrous Ammonia 7500 lbs . 7664-41-7 <br /> 2. <br /> 3. <br /> 4. <br /> 5. <br /> 6. <br /> 7. <br /> 8. <br /> B. Name of Each Regulated Substance in a Mixture Percent Process Max. CAS# <br /> g Weight Quantity(lbs) <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 /> that this certification, executed on the date indicated below, is made under penalty of perjury under the laws of the <br /> State of California. <br /> OWNE�L ERa:NAME(PRINT) <br /> OWNEROPERATOR IGNATURE ATE EXECUTED <br /> a.� �i� QiirO o `;Fo q7 <br />