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0 RECEIVED <br /> COUNTY OF SAN JOAQUIN JAN 2 5 2011 <br /> OFFICE OF EMERGENCY SERVICES SAN JOAQUIN COUNTY <br /> 2101 E.EARHART AVENUE,SUITE 300 OFFICE OFENIERGENCYSUMM <br /> STOCKTON,CA 95206 <br /> �. ./ TELEPHONE(209)953-6200 <br /> FAX(209)953-6268 <br /> 2011 HAZARDOUS MATERIALS MANAGEMENT PLAN AND INVENTORY <br /> CERTIFICATION STATEMENT <br /> (See Reverse Side for Instructions) <br /> 1. Business Identification Page, Hazardous Materials Management Plan, Facility <br /> Man(s) Certification- Check one box only <br /> El I certify that there have been no changes to the above listed documents <br /> since our business' 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 Inventory - Check one box only <br /> 0 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 in regulated quantities 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 L a� 3 kat"/� <br /> � OES Account# 3860 <br /> nr - <br /> X <br /> Site Address l 6 So 0 S /�{/Q��o-, ./� -,4,2 , CA 9 330 <br /> Operator/Owner ,)_, Title ©a.,A� <br /> Signature Date /12-s--/ 20 I <br />