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COUNTY OF SAN JOAQUIN <br /> OFFICE OF EMERGENCY SERVICES DEC - 5 2002 <br /> ROOM 610,COURTHOUSE <br /> 222 EAST WEBER AVENUE S' <br /> ' . <br /> STOCKTON, CA 95202 *TiCZf.;f'�:MERGE?��4 SE94j;.r,E: <br /> TELEPHONE <br /> 8-3962 <br /> HAZARDOUS MA ERIALS DIV209) ISION(209)468-3969 <br /> 2003 HAZARDOUS MATERIALS MANAGEMENT PLAN AND INVENTORY <br /> CERTIFICATION STATEMENT <br /> (See Reverse Side for Instructions) <br /> 1. Business Identification Pae Hazardous Materials Management Plan. Facility <br /> May(s) Certification - Check one box only <br /> ❑ I certify that there have been no changes to the above listed documents <br /> since our business's last update or change was submitted. <br /> ❑ I certify that there has been a change to one or more of the above <br /> documents and that appropriate revised hard copy forms have been <br /> submitted with this Certification Statement. <br /> 2. Certification of Chemical Inventor - Check one box only <br /> ❑ I certify that the information contained in the most recently submitted <br /> chemical inventory is complete, accurate, up-to-date, and contains the <br /> information required by Section 11022 of Title 42 of the United States <br /> Code. I further certify that there has been no change in the quantity of any <br /> hazardous material reported and that no hazardous-materials are being <br /> handled that are not listed. <br /> ❑ I certify that there has been a change in my chemical inventory since the <br /> last submission and completed hard copies of changed Chemical <br /> Description Pages with "Add", "Delete", or"Revised" marked <br /> appropriately have been submitted with this Certification Statement. <br /> I understand that false or inaccurate information may make my company liable in an <br /> emergency. I further certify that I have reviewed the above listed documents and that <br /> the statements checked above constitute an accurate statement. <br /> Business Name Li e -e� k1 y ? CZ 6' OES Account# <br /> Site Address s e g 0 <br /> Operator/Owner A(, t) x F s s o C A Ps Title <br /> Signature �_— l��'� j� v��- Date_ <br />