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SAN JOAQU"OUNTY OFFICE OF EMEARCY SERVICES <br /> HAZARDOUS MATERIALS PROGRAM <br /> RECEIVED <br /> JAN 19 2001 <br /> OMO OFEMERG NQS RE�ICES <br /> DECLARATION OF COMPLETENESS AND ACCURACY <br /> I certify under penalty of law that I have personally reviewed the Hazardous Materials Management <br /> Plan and Inventory submitted by my business and have ensured, to the best of my knowledge, it <br /> meets the requirements of the California Health and Safety Code, Chapter 6.95, Article 1. 1 <br /> understand that false/inaccurate information may contribute to avoidable complications during a <br /> hazardous materials incident. <br /> Nam6 of Business <br /> Name of Facility Operator/Owner <br /> Title of Facility Operator/Owner <br /> L '/'"" � <br /> Signature <br /> (Electronic Signature Acceptable if Legible) <br /> - aoo / <br /> Date <br />