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0 0 <br /> COUNTY OF SAN JOAQUIN <br /> REC <br /> } cL. OFFjCE OF EMERGENCY SERVICES Edi.L. , <br /> 2101 E.EARRART AVENUE,SUITE 300 APR - <br /> STOCKTON,CA.95206 4 2012 <br /> = TELEPHONE(209)953-6200 <br /> FAX(209)953-6268 <br /> r,two H 1�_:;CEPJCVSERV/CE8 <br /> 2D12 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 /> Man(s) Certification- Check one box only <br /> I I certify that there have been no changes to the above listed documents <br /> since our business' 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 /> �1 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 in regulated quantities 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 b1 l P(� MO(X 11 `yl tl�OES Account# <br /> Site Address <br /> Operator/Owner ;:YeTitle�ppX <br /> Signature Datea-{ —1 a, <br />