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0 a <br /> COUNTY OF SAN JOAQUIN RECEIVED <br /> OFFICE OF EMERGENCY SERVICES MAR 24 2011 <br /> 2101 E.EARHART AVENUE,SUITE 300 <br /> STOCKTON,CA 95206 OFFICE OFEMAQGINCOUMTY <br /> TELEPHONE(209)953-6200 MERGENCYG��,,� <br /> f''f «� FAX(209)953-6268 ~"Y '- <br /> 2011 HAZARDOUS MATERIALS MANAGEMENT PLAN AND INVENTORY <br /> CERTIFICATION STATEMENT <br /> (See Reverse Side for Instructions) <br /> 1. Business Identification Page Hazardous Materials Management Plan, Facility <br /> May(s) Certification - Check one box only <br /> I certify that there have been no changes to the above listed documents <br /> since our business' last update or change was submitted. <br /> ❑ 1 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 Inventory - Check one box only <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 in regulated quantities 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 checked above constitute an accurate statement. 2 <br /> Business Name�(�(r} j ( �� OES Account <br /> Site Address X11 e. t' )r- 1A <br /> Operator/Owner Title l <br /> Signature Date � ` � <br />