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! R � 1K__ COUNTY OF SAN JOAQUIN �E� a ' OFFICE OF EMERGENCY SERVICES FEB 14 2= ROOM 610,COURTHOUSE 222 EAST WEBER AVENUE �go. opu lc " STOCKTON,CA 95202 an., .; .'�. TELEPHONE(209)468-3962 ,R i .„ y} HAZARDOUS MATERIALS DIVISION(209)468-3969 2003 HAZARDOUS MATERIALS MANAGEMENT PLAN AND INVENTORY CERTIFICATION STATEMENT (See Reverse Side for Instructions) 1. Business Identification Page Hazardous Materials Management PlanFacility Map(s) Certification- Check one box only 0 1 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 above constitute an accurate statement. 4 co Business Name (pie/l l2rc� k u-O—S 7_190 /e� OES1Account# UoLX7 Site Address p ��S rq, 51 S T DC��t"� Cot Operator/Owner CQ.Y\CXe6I 6 Lo�f(((7�OcTitle (Df� �-Y_ Signature /1 fl,&Z " " Date a— 3 ' 3