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REOEVED <br /> �syln. COUNTY OF SAN JOAQUIN JAN 17 20UZ <br /> '� 'co <br /> ?: = OFFICE OF EMERGENCY SERVICES R aM1YJl it�Uli' LLUI)ITY <br /> a� :� ROOM 610.COURTHOUSE 0MCE 9FtEW11AMICY SERVICES <br /> 222 EAST WEBER AVENUE EMERGENCY OPERATIONS <br /> .. STOCKTON,CALIFORNIA 95202 <br /> �'�b��` TELEPHONE(209)468-3963 <br /> HAZARDOUS MATERIALS DIVISION(209)468-3969 <br /> 2002 HAZARDOUS MATERIALS MANAGEMENT PLAN/INVENTORY <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. ❑ 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/HIvEMP(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, Article 1. <br /> Business Name j! e T(-cy nc,��v%cgnce, Ai' J a, IDES Account# H,52) I <br /> 1 ` <br /> Site Address ?—Lie) g� �, 0��� �+n r I tD uc. �'-A ) TC\L-)� c 1r 7�0 <br /> Facility Operator/Owner 1Po,,\ feekrnucre TitleDi4,-\L11 <br /> � ,rxrvn n <br /> Signature �� 6c-f�(A�y _��c (�� c4a cu Date -OZ- <br />