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..t COUNTY OF SAN JOAQUIN a 3, OFFICE OF EMERGENCY SERVICES RECEIVED ROOM 610,COURTHOUSE DEC - 5 2003 222 EAST WEBER AVENUE ., STOCKTON,CA 95202 SM b'OUNTY TELEPHONE(209)468-3962 pF�NCY SERVICE HAZARDOUS MATERIALS DIVISION(209)468-3969 2004 HAZARDOUS MATERIALS MANAGEMENT PLAN AND INVENTORY CERTIFICATION STATEMENT (See Reverse Side for Instructions) I. Business Identification Page, Hazardous Materials Management Plan, Facility May(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 gabove -constitute an accurate statement. /y Business Name M c W �0.t ctS q I I OES Account ,�_/f 29 I Site Address WW1 �o_A� �` r`�'" Operator/Owner '`` cp r `QAC K Title r_ Signature / L�-A-A� Date 1Z �3