Laserfiche WebLink
RECEIVED <br /> COUNTY OF SAN JOAQUIN <br /> F n VED <br /> OFFICE OF EMERGENCY SERVICES <br /> ROOM 610,COURTHOUSE SANUpppUWCOUNTY <br /> b ` 222 EAST WEBER AVENUE <br /> STOCKTON,CA 95202 FFICEOfEMERGENCYSEBVICE. <br /> TELEPHONE(209)468-3962 <br /> HAZARDOUS MATERIALS DIVISION(209)468-3969 <br /> 2003 HAZARDOUS MATERIALS MANAGEMENT PLAN AND INVENTORY <br /> CERTIFICATION STATEMENT <br /> (See Reverse Side for Instructions) <br /> 1. Business Identification Parte Hazardous Materials Management PlanFaciliky <br /> MK s Certlficati0n - Check one box onl <br /> 1 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 Invento - Check one box onl <br /> 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 c' 'b'�"K �/"I �%checked above constitute an accurate statement. <br /> Business Name C'"�� e Account# �� S 3 <br /> Site Address Lon i"k, ( — <br /> Operator/Owner Title <br /> Signature <br /> Date <br /> j <br />