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°0N <br /> t JAN 18 2002 <br /> COUNTY OF SAN JOAQUIN . ,,,, is <br /> X44 `o� OFFICE OF EMERGENCY SERVICES ORW5 SEP,% <br /> ROOM 610,COURTHOUSE <br /> 222 EAST WEBER AVENUE EMERGENCY OPERATIONS <br /> STOCKTON.CALIFORNIA 95202 <br /> •'�q Cl FOM�`p <br /> TELEPHONE(209)468-3962 <br /> HAZARDOUS MATERIALS DIVISION(209)468-3969 <br /> 2002 HAZARDOUS MATERIALS MANAGEMENT PLAN/INVENTORY <br /> CERTIFICATION STATEMENT <br /> (See Reverse Side for Instructions) <br /> 1. Business Identification Pae BNIM[P Unstaffed Facility Network Attachment. and Facility <br /> Mal - Check one box only <br /> A. ❑ I certify that there have been no changes to the above listed documents since <br /> our business's last update or change was submitted. <br /> B. I certify that there has been a change to one or more of the above documents <br /> and that either 1) appropriate revised hard copy forms, or 2) a complete revised <br /> p electronic copy of our Business ID Page/HNENIP (HIv[W97.FP3 File) and, if <br /> I M I appropriate,our Unstaffed Attachments (STAFF97.FP3 File)has/have been <br /> V translnitted our <br /> with this Certification Statement. <br /> 2. Chemical Inventory (Chemical Description Page) - Check one box only <br /> A. ❑ I certify that the information contained in the most recently submitted chemical <br /> inventory is complete, accurate, up-to-date, and contains the information <br /> required by Section 11022 of Title 42 of the United States Code. I further <br /> certify that there has been no change in the quantity of any hazardous material <br /> / reported and that no hazardous materials are being handled that are not listed. <br /> B, GY I certify that there has been a change in our chemical inventory since the last <br /> AYchemical inventory was submitted and either 1)completed hard copies of <br /> P"J Chemical Description Pages with "Add", "Delete",or"Revised" marked <br /> / appropriately,or 2) a complete revised electronic copy of our chemical <br /> wb inventory (CHEM97 File)has been transmitted with this Statement. <br /> 3. Environmental Contact E-Mail Address (if available) <br /> I understand that false/inaccurate information may make my company liable in an emergency. I <br /> further certify that I have reviewed the above listed documents and information contained in the <br /> most recently submitted chemical inventory and have( d that it meets the requirements of <br /> California Health ad Saf ty Code, Cjjapter 6.95, Articl <br /> Business C e" �' O►ES Account# / /5 <br /> Site Address <br /> Facility Operat �/ Title <br /> « , Date <br /> Sign ure <br />