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0 0 <br /> Jan 03 11 08: 24a San Joaquin Ca OES 2099536261 p. 2 <br /> ;h COUNTY OF SAN JOAQUIN RECE11/Ep <br /> OFFICE OF EMERGENCY SERVICES <br /> 2101 E.EARHART AVENUE,SUITE 300 JAN3 2011 <br /> STOCKTON,CA 95706 <br /> TELEPHONE")913.6200 SANJOgOUjN <br /> FAX(209)953-6268 0 OFEWF?GENCyCOU NTy <br /> SEgVIOIs <br /> 2011 HAZARDOUS MATERIALS MANAGEMENT PLAN AND INVENTORY <br /> CERTIFICATION STATEMENT <br /> (See Reverse Side for Instructions) <br /> 1. Business Identification Page. Hazardous Materials Management Plan. Facility <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'last update or change was submitted. <br /> D I certify that there has been a change to one or more of the above <br /> documents and that appropriate revised hazd copy forms have been <br /> submitted with this Certification Statement. <br /> 2. Certification of Chemical Inventory-Check one box only <br /> Yd 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 in regulated quantities 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 subm?ttcd 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 am accurate statement. <br /> Business Name -T4zfe.0 _ L�jO CES .Account N 71YZI <br /> Site Address;;m jA •lJ . �j Fki.7M.ae a-1. �jZ-10 <br /> Operator/Owner �f9Cp�,peC,e1")lJSy TitleDC 474-4 <br /> Signature �Z S� t�6L�''+-vr �. � Date <br /> I'd 86Z:110 I l CO uef <br />