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npr uw -- --- -- RECEIVED <br /> EJ <br /> APR - 5 2005 <br /> SAN JOAQUIN COUNTY <br /> COUNTY OF SAN JOAOUIN <br /> OFFICE OF EMERGENCY SERVICES <br /> OFFICE OF EjAIROENCY SERVICES <br /> ROOM 610,COl1RTL[OU9E <br /> 121 r,.tS-r WMERAVBNVS <br /> STOCKTON,CA 95202 <br /> TY.tbeHONE(109)44w"1 <br /> HATAADOLTE MATERIALS D":ON W9)466-3969 <br /> 2005 AItDOUS MA RTLALS K Oiv USTATEMENTPLAN AND INVENTORY <br /> (See Reverse Side for Lnstractfous) <br /> 1 s <br /> e ILS aten enl FaC <br /> i�19i$`mr��.�.S,.;n� -Check one baa_anlf <br /> l8 T cerh,v that there have been p4 changes to the above listed documents <br /> since our business's last update of change was submitted. <br /> ❑ l ocrufy that there has twee a change to one or more of the above <br /> documents and that appropriate rovised hard copy forests have been <br /> submitted with this Certification Statement. <br /> 2 _ ,-,...'„ter 1.y rnry .Cherkrine bo OntY <br /> 0 T certify that the information contained in the most recently submitted <br /> chemical inventory is complete,aeeur%te,up-to-date,and contains the <br /> information required by Section 11022 of Title 42 of the United States <br /> Cudc. I further amity that thaw hay boon no chaugo in the yua'3uiy of any <br /> hazardous material reported and that no hazardow materials are being <br /> handled that aro not listed <br /> G 1 certify that there has bee a change in my ehemical inventory since rhe <br /> last submission and completed bard copies of changed Chemical <br /> Description pages with"Add","Delete",or"Revised"marked <br /> appropriately have been submitted with this Cetification Statement. <br /> 1 nuderstaad that false or inaccurate information may make my company liable in au <br /> emergency. f further eerd(y that t bave reviewed the above listed documents and that <br /> the statements chocked above conadtttte an accurate ettttemen <br /> t. <br /> Busirr25s tYatne�f(j` ; OES Account ttj0� <br /> Ste Address -h <br /> OperatorlOtvlter h C Title o 1,)nC r <br /> Signature Date <br /> £d Wd££:£0 SOO2 S0 11dd 89£9 b££ 60, 'ON laid oui 6utplaN 2 autyOpW Pa! Ild WOad <br />