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rA4 y. COUNTY OF SAN JOAQUIN a4'e 'cq� OFFICE OF EMERGENCY SERVICES RONALD a.BALDWIN ROOM 610,COURTHOUSE 222 EAST WEBER AVENUE B • .,, 4• STOCKTON,CALIFORNIA 95202 DEC 2 6 2001 '4�IF0'M1N TELEPHONE(209)468-3962 HAZARDOUS MATERIALS DIVISION(209)468-3969 51111JUAlalillllAVNTY 2002 HAZARDOUS MATERIALS MANAGEMENT PLA V' RY " E(, CERTIFICATION STATEMENT (See Reverse Side for Instructions) 1. Business Identification Page, HNIMP, Unstaffed Facility Network Attachment, and Facility Map - Check one box only A. I certify that there have been no changes to the above listed documents since our business's last update or change was submitted. B. ❑ I certify that there has been a change to one or more of the above documents and that either 1) appropriate revised hard copy forms, or 2) a complete revised electronic copy of our Business ID Page/BACAP (111vIMP971P3 File) and, if appropriate, our Unstaffed Attachments (STAFF97.FP3 File)has/have been transmitted concurrently with this Certification Statement. 2. Chemical Inventory (Chemical Description Pagel - Check one box only A. 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. B. ❑ I certify that there has been a change in our chemical inventory since the last chemical inventory was submitted and either 1)completed hard copies of Chemical Description Pages with "Add", "Delete", or"Revised" marked appropriately, or 2) a complete revised electronic copy of our chemical inventory (CHEM97 File)has been transmitted with this Statement. 3. Environmental Contact E-Mail Address (if available) &DA14e-- I understand that false/inaccurate information may make my company liable in an emergency. I further certify that I have reviewed the above listed documents and information contained in the most recently submitted chemical inventory and have ensured that it meets the requirements of California Health and Safety Code, Chapter 6.95, Article 1. Business Name C041-e 67F-V I /./.0 M14RK eT X CAFE OES Account # ROOD Site Address (3521 P. MARIPCSf- i2j- SIOekTDI\1, C4 9,g'ZIS' Facility Operator/Owner E P 1 Z-1 p 1h A 1 H-sev.O Title A R-f�j e P, (PRINT) Signature Date o J 3C