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6 0 <br /> COUNTY OF SAN JOAQUIN <br /> Fes' OFFICE OF EMERGENCY SERVICES R�CE��EV <br /> ROOM 610,COURTHOUSE VG <br /> .r' 222 EAST WEBER STOCKTON,CA 95202 DEC -5 2003 <br /> TELEPHONE(209)468-3962 MNju YWM' uWNTY <br /> 1044 <br /> V, HAZARDOUS MATERIALS DIVISION(209)468-3969 fRMlFEMER+l <br /> 2004 HAZARDOUS MATERIALS MANAGEMENT PLAN AND INVENTORY <br /> CERTIFICATION STATEMENT <br /> (See Reverse Side for Instructions) <br /> 1. Business Identification Page, Hazardous Materials Management Plan, Facility <br /> Map(s) Certification - Check one box only <br /> Id 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 /> N 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 understand that false or inaccurate information 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 checked above constitute an accurate statement. <br /> Business Name A I lied AlMh1hr s e)ej,"q _OES Account# 5330 <br /> Site Address 1n 1 Fn st Loc u<'t' 5-t - Leal i 84 954 010 <br /> Operator/Owner-Rn�'f Cctibe-✓'tsom Title Aconer <br /> Signature pAgmlt .,A,4& Date /,2 /1 X0,3 <br />