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O P,O.U.!N. C <br /> �. .o <br /> COUNTY OF SAN JOAQUIN <br /> c. OFFICE OF EMERGENCY SERVICES RONALD H. BALDWIN <br /> Iq: < <br /> ROOM 610.COURTHOUSE COORDINATOR <br /> 222 EAST WEBER AVENUE <br /> c'9<ikd RNP STOCKTON. CALIFORNIA 95202 <br /> TELEPHONE(209)6663962 <br /> HAZARDOUS MATERIALS DIVISION(209)46B-3969 <br /> 7;q; <br /> 1998 HAZARDOUS MATERIALS MANAGEMENT PLAMINVENTORY7 <br /> CERTIFICATION FORM ) saN,oApulmc ul:;: <br /> OFFICE OF EMERGENCY SER`,•1;;.= <br /> 1. Business Identification Patte FRAMP Unstaffed Facility Network Attachment and Facility <br /> Man - Check one Box only <br /> A. I certify that there have been m changes to the above listed documents since <br /> our business's last update or change was submitted. <br /> B. ❑ I certify that there has been a change to one or more of the above documents <br /> and that appropriate revised documents are attached to the Certification Form in <br /> accordance with the instructions. <br /> 2. Chemical Inventory (Chemical Description Page) - Check Box A or applicable Box(es) <br /> to BB <br /> A. ❑ I certify that the last chemical inventory submitted to the Office of Emergency <br /> Services has not changed. <br /> B. I certify that there has been a significant change since the last chemical <br /> inventory was submitted and that: <br /> ❑ (1) I have attached copies of Chemical Description Pages of chemicals <br /> removed with "delete" marked at the top. <br /> ❑ (2) I have attached a new Chemical Description Page completed in its <br /> entirety for each new chemical and for each chemical with information <br /> that has changed since our last submission. <br /> I certify that the above information is accurate to the best of my knowledge. I understand that <br /> false/inaccurate information may contribute to complications during a hazardous materials <br /> incident and that I may be <br /> held liable for those actions. <br /> Business Name V'ue ,9 /W/+'/L. a <br /> Site Address e5ZOO S - Z ;dj1 C� 4,A� // f/1/� / y�Jj <br /> Facility Operator/Owner o .J 5- [ Title Pce z id 4., <br /> (PRINT) <br /> Signaturefj�� /�_ Date ry <br />