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�J <br />BUSINESS NAME <br />rj <br />i 1 ! <br />FACILITY STREET ADDRESS/72/-/ cSo, Ci=Ro.�FE <br />CITY /0Z)/CA <br />FACILITY TELEPHONE (Zc 9 ) 3 6 9 - %37-5 <br />& R x <br />P <br />FEB 2 2 1993 <br />N VIRO E T L HEALTH <br />PE.Rmil'USERVICES <br />ZIP 95z 90 <br />MAILING ADDRESS �, ©, -k v S'7,t5 <br />CITY -- r? -F-- M n ci7- L, AA ZIP <br />TELEPHONE( 5/0 ) G 517- 8500 <br />(If diffCn:Mfcom Company Headquarun) <br />LOCAL PRIMARY BUSINESS EMERGENCY CONTACT <br />NAME ___Z i A'V Pe. A T—IT e RESIDENCE G <br />TELEPHONE (O 1,z) (? cif) `i - 2 3 7S' <br />LOCAL ALTERNATE BUSINESS EMERGENCY CONTACT <br />NAME �' ez.� s <br />RESIDENCE <br />TELEPHONE (OFFICE) <br />(HOME) ( ) <br />24-HOUR ON-SITECONTACT /V A <br />.-TELEPHONE ( <br />(If Available) <br />1 declare under the penalty of perjury that I have reviewed this entire Hazardous Materials Manage- <br />ment Plan and it is accurate to the best of my knowledge. I understand that false/inaccurate infor- <br />mation may contribute to complications during a hazardous material incident. This declaration is <br />made in the City of I -O D I oc >��PErn 0,0U_7_ <br />California. <br />NAME OFON•SI TE MANAGER L.A T7-Ee <br />TITLE �R� eHist t <br />cream <br />SIGNATURE OF ON-SITE MANAGER ATE Z, <br />NAMEOFPERSON 4/AeK tSj�tFFt7f �k u/K C�?3n �ikEc7n�E' <br />Responsible for the completion of HMMp D �" TITLE D F SAFETt/ <br />crwn <br />2 <br />lea <br />