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COUNTY OF SAN JOAQUIN RECEIVED hf o, OFFICE OF EMERGENCY SERVICES ROOM 610,COURTHOUSE JAN -7 2004 222 EAST WEBER AVENUE u,^:VJO IdIUR CEIIi14 .,' STOCKTON,CA 95202 r�!vE Ga c�Y, REl iVOt'5 ,3 SCE TELEPHONE(209)468-3962 HAZARDOUS MATERIALS DIVISION(209)468-3969 2004 HAZARDOUS MATERIALS MANAGEMENT PLAN AND INVENTORY CERTIFICATION STATEMENT (See Reverse Side for Instructions) 1. Business Identification Page Hazardous Materials Management Plan, Facility Map(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 ,Vr� 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. Business Name A P/ K P,f/S00 jj 0LOES Account# 822 -7 Site Address ltf 3945S. eOl /,.n��do S- fkn N. 9:5201a/� Operator/Owner 1 'ao do/o /^aV /L,I,CLAt//n hn STitle D wn QA Signature �� V/iCSS" Date