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P )�M COUNTY OF SAN JOAQUIN <br /> OFFICE OF EMERGENCY SERVICES <br /> q ,l` ROOM 610,COURTHOUSE RECEIVED <br /> 222 EAST WEBER AVENUE <br /> STOCKTON,CA 95202 JAN 2 2003 <br /> TELEPHONE(209)468-3962 JYn1�l11PItiUU1NlY <br /> �F���, HAZARDOUS MATERIALS DIVISION(209)468-3969 t 'ENC S•ERMCE <br /> 2003 HAZARDOUS MATERIALS MANAGEMENT PLAN AND INVENTORY <br /> CERTIFICATION STATEMENT <br /> (See Reverse Side for Instructions) <br /> 1. Business Identifitation Pae Hazardous Materials Management Plan Facility <br /> Ma s C kation - Check one box only <br /> I certify that there have been no changes to the above listed documents <br /> I <br /> our business's last update or change was submitted. <br /> ❑ 1 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. Certificatio Chemical Inventory - Check one box only <br /> 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 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 /> I understand that false or inaccurate information may make my company liable in an <br /> emergency. I further certify that I have reviewed the? <br /> he bove listed documents and that <br /> the statements checl d above constitute an accurat tatement. <br /> DiI <br /> Business N e, o �jJ14 ccount# <br /> Site Address <br /> Operator/Owner (i ,1 Title1 10000' <br /> Signature Date 11,1d, 3 <br /> � r <br />