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®r". <br /> COUNTY OF SAN JOAQUIN <br /> OFFICE OF EMERGENCY SERVICES <br /> ROOM 610,COURTHOUSE <br /> 222 EAST WEBER AVENUE <br /> STOCKTON,CA 95202 <br /> TELEPHONE 209 4 B HAZARDOUS MATERIALS DIVISION(209)468-3969 <br /> s�cgR <br /> 2003 HAZARDOUS MATERIALS MANAGEMENT PLAN AND INVENTORY <br /> CERTIFICATION STATEMENT <br /> (See Reverse Side for Instructions) <br /> 1. Business Identification Page Hazardous Materials Management Plan Facile <br /> Map(s) Certification - Check one box only <br /> 1 certify that there have been no changes to the above listed documents <br /> since our business's last update or change was submitted.---- _ -- <br /> ❑ 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 /> l I certify that the information contained in the most recently submitted <br /> chemical inventory is complete, accurate, up-to-date, and contains the <br /> infonnation 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 /> understand tbattalse 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.�&Aae T� J fe A& ES Account# <br /> Site Address <br /> Operator/Owner Title <br /> Signature Date <br />