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0 0 <br />COUNTY OF SAN JOAQUIN <br />OFFICE OF EMERGENCY SERVICES <br />ROOM 610, COURTHOUSE <br />222 EAST WEBER AVENUE <br />STOCKTON, CALIFORNIA 95202 <br />TELEPHONE (209) 466-3962 <br />HAZARDOUS MATERIALS DIVISION (209) 46&3969 <br />RONALD E. BALDWIN <br />COORDINATOR <br />F-_= <br />DEC - 5 1997 <br />1998 HAZARDOUS MATERIALS MANAGEMENT; P NANVENTORY <br />CERTIFICATION FORM ' SAN 30A1 <br />I_-,—JMCE OF EMJIN COUr: <br />�RGENCY <br />1. Business Identification Page HMMP Unstaffed Facility Network Attachment and Fag ty_ <br />Man Check one Box only <br />A. t.Y I certify that there have been n= 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 appropriate revised documents are attached to the Certification Form in <br />accordance with the instructions. <br />Chemical Inventory (Chemical Descriotion Paee) - Check Box A or aunlicable Box(es) <br />in B <br />A. I" I certify that the last chemical inventory submitted to the Office of Emergency <br />Services has not changed. <br />B . I certify that there has been a significant change since the last chemical <br />inventory was submitted and that: <br />❑ (1) I have attached copies of Chemical Description Pages of chemicals <br />removed with "delete" marked at the top. <br />❑ (2) I have attached a new Chemical Description Page completed in its <br />entirety for each new chemical and for each chemical with information <br />that has changed since our last submission. <br />I certify that the above information is accurate to the best of my knowledge. I understand that <br />false/inaccurate information may contribute to complications during a hazardous materials <br />incident and that I may be held liable for those actions. <br />Business Name. ?' // '1�1g7 <br />Site Address,) :3 7(O 041636 (//Q �f <br />Facility Operator/Owner %jii�/�.C/W /e ,� ( AST// ) Title t1)ulN,E/L <br />Date 42-43-27 <br />�J <br />