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ACUTELY HAZARDOUS MATERIALS REGISTRATION FORM <br /> THIS FORM MUST BE COMPLETED BY THE OWNER OR OPERATOR OF EACH BUSINESS IN CALIFORNIA WHICH AT ANY TIME <br /> HANDLES ANY ACUTELY HAZARDOUS MATERIALS IN QUANTITIES, OR IN A MIXTURE, EQUAL TO OR GREATER THAN THE <br /> FEDERAL THRESHOLD PLANNING QUANTITIES FOR EXTREMELY HAZARDOUS SUBSTANCES. SUBMIT THIS COMPLETED <br /> FORM TO YOUR LOCAL ADMINISTRATION AGENCY. (§25533 &25536 Health& Safety Code). <br /> Note Instructions on Reverse /'- <br /> Business Name ��st <br /> �,^ <br /> Business Site Address ✓�0 ��'✓S T C�-�,.I,�.`�- �T. <br /> Business Mailing Address(it different) <br /> f <br /> Business Phone'� u —S Z-� , Business Plan Submission Date 1 <br /> Process Designation 2 <br /> ACUTELY HAZARDOUS MATERIALS HANDLED 3 -use ADDITIONAL PAGES IF NECESSARY- <br /> CHEMICAL NAME QUANTITY 45-0 <br /> -- YKft I muv,-\ Iz 7N s .l <br /> l✓ &C i o 12131 >a 125( oo fi 16 S P—GMQ,J� <br /> 0,30 i3s ov.1 SI7E <br /> GENERAL DESCRIPTION OF PROCESSES AND PRINCIPAL EQUIPMENT <br /> rt"Vno rJ i Ks 1 S U S<�— ' -(-0 <br /> MAW J f=WC4--JA,C <br /> D 1_ C(.L�\4 (,A-JA-n A1(0 2Tr1� ' AYhrVLo,y I A IS D 2l VGnj c7 I— <br /> f-3 —1tC 12ujIAIc. !P&0(_eSS pel.oykD)N(o W/.1 rNS01.017 �ti <br /> CoA710C' S-uCT'VML jk-c t17 IS � s �� �; .ti Piioc �S3 .9 <br /> Goyr lt2o I_ . <br /> /zz�? <br /> SIGNATURE TITLE <br /> PRINTED NAME 4,6 c� A ` "{1 '' -j� DATE <br /> Cawomia OBim of Emergency Semcm FORM NM3M(11-12-89) <br /> V (a) <br />