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M 9 COUNTY OF SAN JOAQUIN OFFICE OF EMERGENCY SERVICES ROOM 610, COURTHOUSE 222 EAST WEBER AVENUE STOCKTON, CA 95202 TELEPHONE (209) 468-3962 HAZARDOUS MATERIALS DIVISION (209) 468-3969 DEC -8 Zoo 2004 HAZARDOUS MATERIALS MANAGEMENT PLAN AND INVENTORY CERTIFICATION STATEMENT (See Reverse Side for Instructions) Business Identification Page, Hazardous Materials Management Plan, Facility ,May/(s) Certification - Check one box only ® I certify that there have been no changes to the above listed documents since our business's last update or change was submitted. ❑ I certify that there has been a change to one or more of the above documents and that appropriate revised hard copy forms have been submitted with this Certification Statement. Certification of Chemical Invento - Check one box onl I certify that the information contained in the most recently submitted chemical inventory is complete, accurate, up-to-date, and contains the information required by Section 11022 of Title 42 of the United States Code. I further certify that there has been no change in the quantity of any hazardous material reported and that no hazardous materials are being handled that are not listed. ❑ I certify that there has been a change in my chemical inventory since the last submission and completed hard copies of changed Chemical Description Pages with "Add", "Delete", or "Revised" marked apyropriareiy ;.ave -been submiacu ,vith this Certification Statement. I understand that false or inaccurate information may make my company liable in an emergency. I further certify that I have reviewed the above listed documents and that the statements checked above constitute an accurate statement. Business Name 'D L lir MAo P;_v(S OES Account # p 5S y Site Address d� 46 Yn146tLi.0 Ukl,LC Operator/Owner MKSI.I &06 —1*1 (,(o Title O CtJt`� Signature i iJ Q aA u � . Date la{o3 /0 At