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..� IVW <br /> COUNTY OF SAN JOAQUIN <br /> r 6 �Ati OFFICE OF EMERGENCY SERVICES RONALD E.BALDWIN <br /> ROOM 610,COURTHOUSE c <br /> 222 EAST WEBER AVENUE f'pMi1� <br /> ^ <br /> *. STOCKTON,CALIFORNIA 95202 <br /> cisbn TELEPHONE(209)468-3962 JAN —8 Hill <br /> HAZARDOUS MATERIALS DIVISION(209)468-3969 'IY <br /> 2002 HAZARDOUS MATERIALS MANAGEMENT PL ANVENT,011f"CE: <br /> CERTIFICATION STATEMENT <br /> (See Reverse Side for Instructions) <br /> 1. Business Identification Page HMMP Unstaffed Facility Network Attachment. and Facility <br /> Map - Check one box only <br /> A. E1' I certify that there have been no changes to the above listed documents since <br /> our business's last update or change was submitted. <br /> B. ❑ I certify that there has been a change to one or more of the above documents <br /> and that either 1) appropriate revised hard copy forms,or 2) a complete revised <br /> electronic copy of our Business ID Page/fINEVIP (HMNIP97.FP3 File) and, if <br /> appropriate, our Unstaffed Attachments (STAFF97.FP3 File)has/have been <br /> transmitted concurrently with this Certification Statement. <br /> 2. Chemical Inventory (Chemical Description Pagel - Check one box only <br /> A. ❑-�_ I certify that the information contained in the most recently submitted chemical <br /> inventory is complete, accurate, up-to-date, and contains the information <br /> required by Section 11022 of Title 42 of the United States Code. I further <br /> certify that there has been no change in the quantity of any hazardous material <br /> reported and that no hazardous materials are being handled that are not listed. <br /> B. ❑ I certify that there has been a change in our chemical inventory since the last <br /> chemical inventory was submitted and either 1)completed hard copies of <br /> Chemical Description Pages with "Add", "Delete", or"Revised" marked <br /> appropriately, or 2) a complete revised electronic copy of our chemical <br /> inventory (CHEM97 File)has been transmitted with this Statement. <br /> 3. Environmental Contact E-Mail Address (if available) <br /> I understand that false/inaccurate information may make my company liable in an emergency. I <br /> further certify that I have reviewed the above listed documents and information contained in the <br /> most recently submitted chemical inventory and have ensured that it meets the requirements of <br /> California Health and Safety Code, CIhaa�pter 6.95, (A.�rticle 1. <br /> Business Name H,•`'�/y/ao &^ (�— � '� ' OES Account# 92_0 <br /> Site Address Co t6 ,�, laa/�C ',_wc / S+"�k�(�t� ' ")520(,0 <br /> Facility Operato Owner C� (J'0 C_X�t'1.V�C_& Title 7�t-y YXC t- <br /> /(P0.-IT1 <br /> Signature Date (?�)CL 10 <br />