Laserfiche WebLink
�eA4,N. COUNTY OF SAN JOAQUIN <br /> ? a OFFICE OF EMERGENCY SERVICES RONALD E.BALDWIN <br /> REEVED <br /> ROOM 610,COURTHOUSE <br /> 222 EAST WEBER AVENUE EMERGENCY OPERATIONS <br /> • c.., �F• STOCKTON,CALIFORNIA 95202 DEC -6 2W1 <br /> �tippp <br /> TELEPHONE(209)468-3962 <br /> HAZARDOUS MATERIALS DIVISION(209)468-3969 SANJUAUOINCUUNIY <br /> 9M IIF EMERGENCY SERVICES <br /> 2002 HAZARDOUS MATERIALS MANAGEMENT PLANANVENTORY <br /> CERTIFICATION STATEMENT <br /> (See Reverse Side for Instructions) <br /> 1. Business Identification Page. HMMP, Unstaffed Facility Network Attachment. and Facility <br /> Map - Check one box only <br /> A. Ci, I certify that there have been no 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 either 1) appropriate revised hard copy forms, or 2) a complete revised <br /> electronic copy of our Business ID Page/HM?VP(HMMP97.FP3 File) and, if <br /> appropriate, our Unstaffed Attachments (STAFF97.FP3 File) has/have been <br /> transmitted concurrently with this Certification Statement. <br /> 2. Chemical Inventory (Chemical Description Page) - Check one box only <br /> A. I certify that the information contained in the most recently submitted chemical <br /> Inventory is complete, accurate,up-to-date, and contains the information <br /> required by Section 11022 of Title 42 of the United States Code. I further <br /> certify that there has been no change in the quantity of any hazardous material <br /> reported and that no hazardous materials are being handled that are not listed. <br /> B. ❑ I certify that there has been a change in our chemical inventory since the last <br /> chemical inventory was submitted and either 1)completed hard copies of <br /> Chemical Description Pages with "Add", "Delete",or"Revised"marked <br /> appropriately, or 2) a complete revised electronic copy of our chemical <br /> inventory (CHEM97 File)has been transmitted with this Statement. <br /> 3. Environmental Contact E-Mail Address (if available) <br /> I understand that false/inaccurate information may make my company liable in an emergency. I <br /> further certify that I have reviewed the above listed documents and information contained in the <br /> most recently submitted chemical inventory and have ensured that it meets the requirements of <br /> California Health and Safety Code, Chapter 6.95, <br /> Article 1. <br /> Business Name ��1 Cir��IIcC I �U' I ��r7, OES Account#124 <br /> Site Address <br /> Facility Operator/Owner ' l/ �C�J Title <br /> (PRIM) <br /> Signature Date q=:L <br />