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*%W `r PL7-":IVSD <br /> COUNTY OF SAN JOAQUIN DEC -9 2002 <br /> .,.rur. OFFICE OF EMERGENCY SERVICES <br /> 7a {(y <br /> ROOM 610,COURTHOUSE �" � GIEP &ZIV <br /> ICE <br /> 222 EAST WEBER AVENUE <br /> STOCKTON,CA 95202 <br /> TELEPHONE(209)468-3962 <br /> HAZARDOUS MATERIALS DIVISION(209)468-3969 <br /> 2003 HAZARDOUS MATERIALS MANAGEMENT PLAN AND INVENTORY <br /> CERTIFICATION STATEMENT <br /> (See Reverse Side for Instructions) <br /> 1. Business Identification Paee Hazardous Materials Management Plan, Facility <br /> Map(s) Certification - Check one box only <br /> I certify that there have been no changes to the above listed documents <br /> since our business!s 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. 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 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 understandthafl'alse or maccuratee i�ation 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 cheeccked above constitute an accurate statement. G <br /> ,.,,e, cts �u�. OES Account# t715 <br /> Business Name eO h <br /> Site Address \l z-g-7p C - rJ.oe, <br /> Operator/Owner I�Ot i.0 Title <br /> Signature Date <br />