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HAZARDOUS MATERIALS <br /> EMERGENCY RESPONSE PLAN <br /> or Hazardous wants contingency Plan <br /> Environmental Health Services <br /> Business Plan <br /> Date:September 11, 1996 <br /> BUSINESS IDENTIFICATION DATA <br /> USA PETROLEUM GASOLINE STATION # 65 <br /> BUSINESS NAME <br /> 2500 W. LODI LODI 96001 <br /> SITE ADDRESS <br /> USA PETROLEUM GASOLINE STATION # D65 IIP GDDII <br /> FACILITY 209 333 9823 <br /> 30101 AGOURA COURT AGOURA HILLS CATELEPHONE <br /> BUSIN385 MAILING ADDRESS 91301-4311 <br /> CITY <br /> BIP CODE <br /> If Your business has a license o ermit frm a of the fellwin erries, lee indicate the document number. <br /> 1 . Hazardous Materials F4 . <br /> ir Pollution Control Dist. # <br /> Underground Storage #1356 <br /> 2 . County Health Dept. H esponding Fire Dept. & PermitHazardous Waste #1356 <br /> Please provide the following information as it pertains to your business and <br /> its location. You are not required to notify these companies in the event of <br /> , an emergency. This information is provided for your reference and to assist <br /> emergency response personnel in responding to a hazardous materials emergency <br /> at your facility. Listhe name and phone of the utility company. <br /> Electric Service: Cr yo- p"2„ ,p -4,735 Gas Service: f5 rF i- X6o- 7-3 - Saar <br /> Sanitation District; ("" -'-ta's -VSX Water District: v�/ 5�35- <br /> P <br /> OWNER CERTIFICATION OF DATA (Certify either 1 or 2) <br /> 1 . This is a ;_; New Plan ;7P <br /> Updated Existing Plan I have <br /> personally examined the information it contains and am familiar with the <br /> operation of the plan. ( If you check either of the above two options, <br /> continue to accomplish the remainder of the Emergency Response/Contingency <br /> Plan) . <br /> 2 . ;_; This plan requires no change and is on file Environmental <br /> Health Services. (If you check this section, please proceed directly to the <br /> Training Program) . <br /> I certify under penalty of law that the above information is true and <br /> accurate. <br /> USA PETROLEUM CORP September 11 1996 <br /> BAMII OF ONRIIR �/� <br /> DAVID K. OLDFIELD �_c� y `_ DASII <br /> Se tember 11 1996 <br /> DOCUMENTS PREPARED BY SIG■ TURN DATE <br /> 1 <br />