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COUNTY OF SAN JOAQUIN RE EIVE® <br /> x OFFICE OF EMERGENCY SERVICES <br /> ROOM 610,COURTHOUSE JAN 2 0 2094 <br /> 222 EAST WEBER AVENUE <br /> ? STOCKTON,CA 95202 sM/dU Wl a uuuNlY <br /> ' TELEPHONE(209)468-3962 MMOFEM GE14CYSERIACE <br /> ' 1 HAZARDOUS MATERIALS DIVISION(209)468-3969 <br /> 2004 HAZARDOUS MATERIALS MANAGEMENT PLAN AND INVEN7iR'i' ",v <br /> CERTIFICATION STATEMENT <br /> (See Reverse Side for Instructions) JAN 2 9 2004 <br /> I. Business Identification Page, Hazardous Materials Management Plan, FaClTrt� <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's last update or change was submitted. <br /> 1 I 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 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. <br /> Business Name &4- +X o f S4cek+,nn OES Account# .2 76 2- <br /> Site Address7K`/f//7`� 9,5a/d <br /> Operator/Owner ,,�j5s 0 JCC �,t/ Title Y <br /> Signature Date <br />