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COUNTY OF SAN JOAQUIN <br /> OFFICE OF EMERGENCY SERVICES REOEIVED <br /> v v ROOM 610,COURTHOUSE <br /> 222 EAST WEBER AVENUE FEB 18 2003 <br /> STOCKTON,CA 95202 <br /> TE2 <br /> HAZARDOUS MATERIALS DIVISION(209)468-3969W&=W <br /> '..}1F6R... <br /> 2003 HAZARDOUS MATERIALS MANAGEMENT PLAN AND INVENTORY <br /> CERTIFICATION STATEMENT <br /> (See Reverse Side for Instructions) <br /> 1. Business Identification Page, Hazardous Materials Management Plan. Facility <br /> Map(s) Certification- Check one box only <br /> I certify that there have been no changes to the above listed documents <br /> since our business's last-update-or change wasssubmitted -� <br /> ❑ I certify that there has been a change to one or more of the above <br /> documents and that appropriate revised hard copy forms have been <br /> submitted with this Certification Statement. <br /> 2. Certification of Chemical Inventory - Check one box only <br /> I certify that the information contained in the most recently submitted <br /> chemical inventory is complete, accurate, up-to-date, and contains the <br /> information required by Section 11022 of Title 42 of the United States <br /> Code. I further certify that there has been no change in the quantity of any <br /> hazardous material reported and that no hazardous materials are being <br /> handled that are not listed. <br /> ❑ I certify that there has been a change in my chemical inventory since the <br /> last submission and completed hard copies of changed Chemical <br /> Description Pages with "Add", "Delete", or"Revised" marked <br /> appropriately have been submitted with this Certification Statement. <br /> I understand that false or inaccurate information may-make m'y company liable in an <br /> emergency. I further certify that I have reviewed the above listed documents and that <br /> the statements checked above constitute an accurate statement. <br /> Business Name ( o k- I etc � f end Cr5 5( oj/ O�S Account# <br /> Site Address (� "L hT �ro a d t lc w Loe <br /> Operator/Ower v01 Title Dt C / <br /> c <br /> Signature 14= <br /> Date [ I f Q <br />