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REOEIVED <br /> JAN 17 2002 <br /> COUNTY OF SAN <br /> r. <br /> OA UIN SANJUAUUlN COUNTY <br /> OCROBRV <br /> ICEsOFFICE OF EMERGENCY SVICES N LDE. ALDWIN <br /> a`. . ROOM 610,COURTHOUSE DIRECTOR OF <br /> 222 EAST WEBER AVENUE EMERGENCY OPERATIONS <br /> •iT..,, _ ;F• STOCKTON,CALIFORNIA 95202 <br /> <Iaoy1T+ TELEPHONE(209)468-3962 <br /> HAZARDOUS MATERIALS DIVISION(209)468-3969 <br /> 2002 HAZARDOUS MATERIALS MANAGEMENT PLAN/INVENTORY <br /> CERTIFICATION STATEMENT <br /> (See Reverse Side for Instructions) <br /> 1. Business Identification Page HMMP Unstaffed Facility Network Attachment and Facility <br /> Map - Check one box only <br /> A. T( I certify that there have been no 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 either 1) appropriate revised hard copy forms,or 2) a complete revised <br /> electronic copy of our Business ID Page/HNEWP (HMMP97.FP3 File) and, if <br /> appropriate, our Unstaffed Attachments (STAFF97.FP3 File) has/have been <br /> transmitted concurrently with this Certification Statement. <br /> 2. Chemical Inventory (Chemical Description Pagel - Check one box only <br /> A. I certify that the information contained in the most recently submitted chemical <br /> inventory is complete, accurate, up-to-date, and contains the information <br /> required by Section 11022 of Title 42 of the United States Code. I further <br /> certify that there has been no change in the quantity of any hazardous material <br /> repotted and that no hazardous materials are being handled that are not listed. <br /> B. ❑ I certify that there has been a change in our chemical inventory since the last <br /> chemical inventory was submitted and either 1) completed hard copies of <br /> Chemical Description Pages with "Add", "Delete", or"Revised"marked <br /> appropriately, or 2) a complete revised electronic copy of our chemical <br /> inventory (CHEM97 File)has been transmitted with this Statement. <br /> 3. Environmental Contact E-Mail Address (if available) o w k s 4a <br /> U ' <br /> I understand that false/inaccurate information may make my company liable in an emergency. I <br /> further certify that I have reviewed the above listed documents and information contained in the <br /> most recently submitted chemical inventory and have ensured that it meets the requirements of <br /> California Health and Safety Code, Chapter 6.95, Article 1. <br /> Business Name t* /Z 1 OES Account# 3 59 <br /> II ��AA <br /> Site Address �/96 (t,�/Kct .�-m,. w /9✓k,lu5- /rAyAr ., CA 7,5q,? <br /> Facility Operator/Owner )q 446 vL a ewo4/�1dlrg-T4 KALA Title 6,441c/ti.rkk s <br /> C� (PRINT) 1 <br /> Signature ck {Y 11 f ka L,� - Date t 1^ �— <br />