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COUNTY OF SAN JOAQUIN ��cc `'C ,J off, OFFICE OF EMERGENCY SERVICES FIGM'V ED ROOM 610,COURTHOUSE �f W�io, 222 EAST WEBER AVENUE DEC -5 2W3 STOCKTON,CA 95202TELEPHONE(209)468-3962WO&OW S R CE HAZARDOUS MATERIALS DIVISION(209)4683969 2004 HAZARDOUS MATERIALS MANAGEMENT PLAN AND INVENTORY CERTIFICATION STATEMENT (See Reverse Side for Instructions) I. Business Identification Pape Hazardous Materials Management Plan Facility Map(s) Certification - Check one box only jig- 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 t S 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. Business Name Q U S /y r,4-nis 7�v m, 4" OES Account# 5, 3 )L— Site Site Address � i )-- (3 "w A v-2 4 1) e_.C" . Operator/Owner Ti K,,r.7eS S '; C ia,*,% Title 146 le- Signature .9 Date 243 -3!� �J