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... .. �� �.. .. . .... �� ... .. ,.oma p. a <br /> Rpr 22 10 31 :33a San Jo -uin Ca OES 2099536261 p.2 <br /> v <br /> COUNTY OF SAN JOAQUIN Reco <br /> —i^ OFFICE OF EMERGENCY SERVICES ��® <br /> 2101 h.bARHART AVENUE,SUITE 300 <br /> } STOCKTON,CA 95206 APR2 2 C9O,O <br /> TELEPHONEr1097953-6700 <br /> F.4x(209)953 Q68 JAN <br /> JFFICfOFEMERWIYy FRVICfg <br /> 2010 HAZARDOUS MATERIALS MANAGEMENT PLAN AND INVENTORY <br /> CERTIFICATION STATEMENT <br /> (See Reverse Side for Instructions) <br /> 1. Business Identification Pagc,Hazardous Materials Mana¢ement Plan Facility <br /> Mans) rtifi <br /> Cecation- Check one box on <br /> 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 /> 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. 1 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 /> ❑ 1 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 1 have reviewed the above listed documents and that <br /> the statements checked above constitute <br /> �an/accurate statement. ` <br /> Business Name 'V\ ) _j LIr.C��,LJ*OES Account <br /> Site Address aU ) _ w, lel'. I • �� <br /> Operator/Owner , ____ TitleJ <br /> Signature _ Date _ -1�/____ <br />