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HAZARDOUS MATERIALS <br /> EMERGENCY RESPONSE PLAN <br /> or Hazardous Waste Contingency Plan <br /> Environmental Health Services Business Plan <br /> Date:August 20, 1997 <br /> BUSINESS IDENTIFICATION DATA <br /> USAPETROLEUM GASOLINE STATION # 65 <br /> BUSINESS NAME <br /> 2500 W. LO D I LO D I 96001 <br /> WE ADDRESS CITY ZIP CODE <br /> USAPETROLEUM GASOLINE STATION # 65 209-333-9823 <br /> WRIT UNIT TELEPHONE NO, <br /> 30101 AGOURA COURT AGOURA HILLS, CA 913OIA311 <br /> BUSINESS HAILING ADDRECITY ZIP CODE <br /> 1. Hazardous Materials 3. Air Pollution Control Dist. # <br /> Underground Storage #1356 <br /> 2. County Health Dept. 4. Responding Fire Dept. & Permit Vs <br /> Hazardous Waste #1356 <br /> Please provide the following information as it pertains to your business and its location. You are not <br /> required to notify these companies in the event of an emergency. This information is provided for <br /> your reference and to assist emergency response personnel in responding to a hazardous materials <br /> emergency at your facility. List the name and phone of the utility company. <br /> Electric Service: Gas Service: <br /> Sanitation District: Water District: <br /> OWNER CERTIFICATION OF DATA (Certify either 1 or 2) <br /> 1. This is a _New Plan %_Updated Existing Plan I have personally examined the <br /> information it contains and am familiar with the operation of the plan. (If you check either of the <br /> above two options, continue to accomplish the remainder of the Emergency Response/ Contingency <br /> Plan). <br /> 2. _This plan requires no change and is on file Environmental Health Services. (If you check <br /> this section, please proceed directly to the Training Program). <br /> I certify under penalty of law that the above information is true and accurate. <br /> USAPETROLEUM CORP August 20. 1997 <br /> NAME OF OWNER DATE <br /> DAVID K OLDFIELD August 20, 1997 <br /> DOCUMENTS PREPARED BY SIGNATURE DATE <br /> WRP PG.#5 <br />