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HAZARDOUS MATERIALS MANAGEMENT PLAN AND INVENTORY <br /> CERTIFICATION STATEMENT <br /> 2004 Instruction Sheet <br /> Use this form to meet certification requirements if you are not using the HMMP <br /> Compliance Web Site to submit your certification. <br /> Please review your HMMP and inventory and follow these instructions. <br /> 1. If there are no changes to the Business Identification Page,Hazardous Materials <br /> Management Plan (HMMP), Unstaffed Facility Network Attachment(s) (if <br /> applicable), and Facility Map(s) that you last submitted to the Office of <br /> Emergency Services, then place a check in the first box under Statement#1. <br /> 2. If there have been anx changes to one of the documents listed in#1 above, <br /> then submit a hard copy of the revised document(s) completed in its entirety <br /> with the corrected information along with the signed and dated Certification <br /> Statement. Blank forms are available at the San Joaquin County Office of <br /> Emergency Services, 222 E. Weber Avenue,Room 610, Stockton. <br /> Place a check in the second box under Statement#1 prior to signing the form. <br /> 3. If there are no changes to the chemical inventory, including no change in <br /> quantities previously reported, then place a check mark in the first box under <br /> Statement#2. <br /> 4. If there has been a change to the chemical inventory reported for one or more <br /> chemicals, please make updates as follows. Submit a completed hard copy of <br /> changed or new Chemical Description Page(s) marked"Add" or"Revised." If <br /> you have deleted a chemical from your inventory, send a copy of the last chemical <br /> description page submitted marked"delete" at the top. Submit these updated <br /> documents together with the Certification Statement. <br /> 5. Make sure there is a check mark in one of the boxes under both Statement#I and <br /> Statement#2, then sign and date the Certification Statement and submit to our <br /> office with the appropriate updated forms by the deadline of January 16, 2003. <br /> NOTE: State law requires that you report a 100% change in the quantity of a <br /> previously reported material. <br /> Be sure to update the copy of your HMMP and inventory used by your employees <br /> with the same changes. If you need assistance,please call our office at (209) 468 3969. <br />