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RECCE= COUNTY OF SAN JOAQUIN JAN 15 2003 OFFICE OF EMERGENCY SERVICES ? , ROOM 610,COURTHOUSE hr,r± • 171-7.5-y 222 EAST WEBER AVENUE IFFlGE(W&.1ERGENGr'SERVICE STOCKTON,CA 95202 r�r TELEPHONE(209)468-3962 HAZARDOUS MATERIALS DIVISION(209)468-3969 2003 HAZARDOUS MATERIALS MANAGEMENT PLAN AND INVENTORY CERTIFICATION STATEMENT (See Reverse Side for Instructions) 1. Business Identification Page Hazardous Materials Management Plan Facility MaD(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. 2. Certification of Chemical Inventory - Check one box only xI 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 appropriately have been submitted with 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 ColItggl el�� mm)6+% Calle, OES Account# �(7 Site Address 13521 ��• fvlA�XiSJO�oi of Q-�pe�c�pi., � �IS Operator/Owner �Nv.lnQ l�la� Title -PcV�V Signature O Date