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REOEIVED <br /> FtB 6 ?QU <br /> SHNJURQUIN CAi1NTY <br /> COUNTY OF SAN JOAQUIN onpF6XRGENCYSERAGES <br /> aQRR�•Cp <br /> r: / TCE OF EMERGENCY SERVICES RONALD E:BALDWIN <br /> �EIx!I <br /> ei `r" ROOM 610,COURTHOUSE DIRECTOR OF <br /> .yyy� 222 EAST WEBER AVENUE EMERGENCY OPERATIONS <br /> • �' <br /> ........ .NSTOCKTON,CALIFORNIA 95202 <br /> `/1� . ( <br /> R=�E� °� jWMWOUS MATERIALS209)DIVIS ON(209)468-3969 <br /> J(iN _ yHtt20A022MHAA8-392 <br /> cZTARDOUS MATERIALS MANAGEMENT PLAN/INVENTORY <br /> SANA*jaUfNu0uN1Y CERTIFICATION STATEMENT <br /> 0FGENCYSERffZ (See Reverse Side for Instructions) <br /> 1. Business Identification Page, MIME, Unstaffed Facility Network Attachment and Facility <br /> MaD - Check one box only <br /> A. 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/HMMP(HM1"p97.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, Chapter <br /> 6.95, Article 1. p <br /> Business Name_C--Z- el 0_U2(-_'5;TPCA (I.e-� � Aj T OES Account# 0 <br /> Site Address�3 �S S l% ��OrCLC,C`o S7-ryn`j j( I(j,\) <br /> Facility Operator/Owner clnhcj twf'1 oy�C��LIS7s Title <�Ll� /V� Y" t� <br /> Si nature! C/C�2 I / <br /> g Date <br />