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RECEIVED COUNTY OF SAN JOAQUIN J 4 N -8 2003 OFFICE OF EMERGENCY SERVICES ROOM 610,COURTHOUSE 1 222 EAST WEBER AVENUE rt STOCKTON,CA 95202 TELEPHONE(209)468-3962 . HAZARDOUS MATERIALS DIVISION(209)468-3969 2003 HAZARDOUS MATERIALS MANAGEMENT PLAN AND INVENTORY CERTIFICATION STATEMENT (See Reverse Side for Instructions) 1. Business Identification Page, Hazardous Materials Management Plan Facility Man(s) Certification - Check one box only 1 certify that there have been no changes to the above listed documents since our business's last update or change was submitted. ❑ I certify that there has been a change to one or more of the above documents and that appropriate revised hard copy forms have been submitted with this Certification Statement. 2. Certification of Chemical Inventory - Check one box only I certify that the information contained in the most recently submitted chemical inventory is complete, accurate, up-to-date, and contains the information required by Section 11022 of Title 42 of the United States Code. I further certify that there has been no change in the quantity of any hazardous material reported and that no hazardous materials are being handled that are not listed. ❑ I certify that there has been a change in my chemical inventory since the last submission and completed hard copies of changed Chemical Description Pages with"Add", "Delete", or"Revised" marked appropriately have been submitted with this Certification Statement. I understand that false or inaccurate information may make my company liable in an emergency. I further certify that I have reviewed the above listed documents and that the statements checked above constitute an accurate statement. Business Name :nyn ch-Q— ixt iIn�OES Account Site Address Operator/Owner Title e(-X-f1+ Signature Date rL, C�S ano.