COMPLIANCE INFO - Laserfiche WebLink

Home Browse Search

COUNTY OF SAN JOAQUIN OFFICE OF EMERGENCY SERVI C):—GS4j07N3D E.BALDWIN ROOM 610,COURTHOUSE DIRECTOR OR 222 EAST WEBER AVENUEJAN 13 2 .1,�.RGECYOPERATIONS �(�� STOCKTON,CALIFORNIA 95202 TELEPHONE(209)468-3962 �.y or,r In,..y rr •r._ HAZARDOUS MATERIALS DIVISION(209)468-3A49,,,E Gl Ei9iERGENi:1"SERVICE'. 2003 HAZARDOUS MATERIALS MANAGEMENmT1iPLAN/INVENTORY CERTIFICATION STATEMENT (See Reverse Side for Instructions) 1. Business Identification Page, HMMP, Unstaffed Facility Network Attachment, and Facility May - Check one box only. A. 0 I certify that there have been no changes to the above listed documents since our business's last update or change was submitted. B. I certify that there has been a change to one or more of the above documents and that either 1) appropriate revised hard copy forms, or 2) a complete revised electronic copy of our Business ID Page/HMMP (HMMP97.FP3 File) and, if appropriate, our Unstaffed Attachments (STAFF97.FP3 File)has/have been transmitted concurrently with this Certification Statement. 2. Chemical Inventory(Chemical Description Page) - Check one box only A. 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 hazardous material reported and that no hazardous materials are being handled that are not listed. B. 0 1 certify that there has been a change in our chemical inventory since our last chemical inventory was submitted and either 1) complete hard copies of Chemical Description Pages with"Add", "Delete", or "Revised"marked appropriately, or 2) a complete revised electronic copy of our chemical inventory (CHEM97.FP3 File) has been transmitted concurrently with this Certification Statement. 3. Environmental Contact E-Mail Address (if available): pam.ruesgaRconocophillips.com I understand that false/inaccurate information may make my company liable in an emergency. I further certify that I have reviewed the above listed documents and information and information contained in the most recently submitted chemical inventory and have ensured that is meets the requirements of California Health and Safety Code,Chapter 6.95,Article 1. Business Name Circle K 76#2705447 OES Account# (0 � Site Address 1469 E. Hammer Lane, Stockton CA 95210 Facili Operat /Owner'f �i /�« {/l/��t Titled &Aw2f6-1 Signature Dato��7�b�I�