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, (u RECEIVED <br /> MAR 2 9 2002 <br /> COUNTY OF SAN JOAQUIN <br /> OFFICE OF EMERGENCY SERVICES SFR +ER <br /> ROOM 610,COURTHOUSE "DW SVICE'� <br /> 222 EAST WEBER AVENUE EMERGENCY OPERATIONS <br /> ci .ox' STOCKTON,CALIFORNIA 95202 <br /> TELEPHONE(209)468-3962 <br /> HAZARDOUS MATERIALS DIVISION(209)468-3969 <br /> 2002 HAZARDOUS MATERIALS MANAGEMENT PLAN/INVENTORY <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. )< 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/HWP (HMMP97.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 Page) - Check one box only <br /> A. X 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) dcal�afays 0 �o�t.gov <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. <br /> Business Name GIT`( or- L-0D1 OES Account # 130 <br /> Site Address 210 yW� - 7;1 r l_Dpt I cA- 1 S-z-g_O <br /> Facility Operator/Owner IJ>:NNt`� S• GA�I.I.A�F4>+41� Title TalFAcAt IM5 MjkuA GL <br /> (PRINT) <br /> Signature <77 I O Date 31�g/OZ- <br />