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COUNTY OF SAN JOAQUIN RECEIVED OFFICE OF EMERGENCY SERVICES 3 ox' ROOM 610,COURTHOUSE DEC -5 L003 1 ) 222 EAST WEBER AVENUE BMJDA6xlm(;OUN1Y STOCKTON,CA 95202 FMOFEMERGENICWSERME TELEPHONE(209)468-3962 HAZARDOUS MATERIALS DIVISION(209)468-3969 2004 HAZARDOUS MATERIALS MANAGEMENT PLAN AND INVENTORY CERTIFICATION STATEMENT (See Reverse Side for Instructions) 1. Business Identification Page, Hazardous Materials Management Plan, Facility Map(s) Certification - Check one box only I certify that there have been no changes to the above listed documents since our business's last update or change was submitted. ❑ I certify that there has been a change to one or more of the above documents and that appropriate revised hard copy forms have been submitted with this Certification Statement. 2. Certification of Chemical Inventory - Check one box only 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 any hazardous material reported and that no hazardous materials are being handled that are not listed. ❑ I certify that there has been a change in my chemical inventory since the last submission and completed hard copies of changed Chemical Description Pages with "Add", "Delete", or"Revised"marked appropriately-have been submitted with this-Certification Statement. I understand that false or inaccurate information may make my company liable in an emergency. I further certify that I have reviewed the above listed documents and that the statements checked above constietutan accurate statement. Ori Business Name 0 O C--t t_rl 4V 1GtJ1 !C* ) OES Account # Od) 19 —r Site Address tolM 5A,- CA- gS2,00 Operator/Owner NAer— :r eoae_H Title DiN-e,C Signature Date iala IOZ)