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P� (H COUNTY OF SAN JOAQUIN <br /> av '.ate OFFICE OF EMERGENCY SERVICES RONALD E.BALDWIN <br /> ROOM 610,COURTHOUSE DIR=OR OF <br /> 222 EAST WEBER AVENUE ETIECHMD <br /> .., p. STOCKTON,CALIFORNIA 95202TELEPHONE V G <br /> ,� FOPN <br /> 8-392 <br /> HAZARDOUS MATER AL3 DMS ON (209)468-3969 JAN -4 2002 <br /> 2002 HAZARDOUS MATERIALS MANAGEMENT PLANYSE�RVICEt <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/B IIgP (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 Inventor (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 Q�% I [ OES Account# a? 7 <br /> Site Address q 1 444act,4 /0(14 .4t A - <br /> Facility <br /> Facility Operator/Owner J E CN OE RT Tide2A4 io. 4 t dlgtH qa <br /> (PRINT) <br /> Si Date O/"OZ — O Z— <br />