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P-CEIVED F E H 27 2004 COUNTY OF SAN JOAQUIN 5%iiaumu• ltjuuuNiy * a, OFFICE OF EMERGENCY SERVICES cftCtOFEMERGENCY SERVICE ar ,) ROOM 610,COURTHOUSE 222 EAST WEBER AVENUE _ STOCKTON,CA 95202 - ,�,. TELEPHONE(209)4CB-3962 " 6i*�'pj!•' HAZARDOUS MATERIALS DNISION('09)469-3969 2004 HAZARDOUS MATERIALS MANAGEMENT PLAN AND INVENTORY CERTIFICATION STATEMENT (See Reverse Side for Instructions) 1. Business Identification Page hazardous Materials Management Plan Facili Man(s) Certification - Check one box only I certify that there have been no changes to the above listed documents since our business's last update or change was submitted. ❑ I certify that there has been a change to one or more of the above documents and that appropriate revised hard copy forms have been submitted with this Certification Statement. 2. Certification of Chemical Inventory - Check one box only I certify that the information contained in the most recently submitted chemical inventory is complete, accurate, up-to-date, and contains the information required by Section 11022 of Title 42 of the United States Code. I further certify that there has been no change in the quantity of any hazardous material reported and that no hazardous materials are being handled that are not listed. ❑ I certify that there has been a change in my chemical inventory since the last submission and completed hard copies of changed Chemical Description Pages with "Add", "Delete", or"Revised"marked appropriately have been submitted with this Certification Statement. I understand that false or inaccurate information may make my company liable in an emergency. I further certify that I have reviewed the above listed documents and that the statements checked above constitute an accurate statement. 1073 Business Name mn t[nkt y, f• OLtL0 G S OES Account# 40" Ih3 00 u.) • bomm_ F -;"- Site Address Operator/Owner �� Title rn;tft�.� Ye t 41 CG 1ttCJ/i, Signature Date