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py <br /> COUNTY OF SAN JOAQUIN 0 <br /> ����sErtcrsER css <br /> ,a6 •o� OFFICE OF EMERGENCY SERVICES RONALDBALDWtN <br /> ROOM 610,COURTHOUSEDIRECCOR OF <br /> 222 EAST WEBER AVENUE K EMERGENCY OPERATIONS <br /> STOCKTON,CALIFORNIA 95202 <br /> C'P�I Fb 44 TELEPHONE(209)468-3962 <br /> HAZARDOUS MATERIALS DIVISION(209)468-3969 <br /> 2002 HAZARDOUS CERTIFICATIONMATERIALS <br /> MAGSM N TPLAN/INVENTORY <br /> (See Reverse Side for instructions) <br /> 1. Business Identification Pie 11MIVIP Unstaffed Facility Network Attachment and Facility <br /> Map - 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 IDPage/HMMP (BMM1V1P97.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 6.95, Article 1. p <br /> L� L)�L� G � l(' -� c(�/l(P C� OES Account# 0� <br /> Business Name <br /> 2 Ste/ <br /> Site Address / \ <br /> CFacility Operator/Owner Title nC Q /VC r <br /> / /per (PRIM1 /�,, <br /> Signature�C/C%2 �� Date lY — 0 <br />