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JAN 2 0 <br /> COUNTY OF SAN JOAQU <br /> o�c"•'n.. I1V <br /> a'm OFFICE OF EMERGENCY SERVICESO SAN E.R.ea wt 1 <br /> fF7Cf <br /> ROOM 610,COURTHOUSE Of fMERGfN �R r <br /> 222 EAST WEBER AVENUE EMER f 1^ RATIONS <br /> -., - STOCKTON, CALIFORNIA 95202 <br /> TELEPHONE(209)468-3962 <br /> HAZARDOUS MATERIALS DIVISION(209)468-3969 <br /> 2000 HAZARDOUS MATERIALS MANAGEMENT PLAN/INVENTORY <br /> CERTIFICATION STATEMENT <br /> (See Reverse Side for Instructions) <br /> 1. Business Identification Pae HMMP Unstaffed Facility Network Attachment and Facility <br /> Ma - Chpfk one box onl . <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 /> electronic copy of our Business ID Page/HMMP(HMMP97.FP3 File) and, if <br /> appropriate, our Unstaffed Attachments (STAFF97.FP3 File) has/have been <br /> transmitted concurrently with this Certification Statement. <br /> 2. Chemical vento Chemical Description Pae - 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. ❑ I certify that there has been a change in our chemical inventory since the last <br /> chemical inventory was submitted and either 1)completed hard copies of <br /> Chemical Description Pages with"Add","Delete", or"Revised"marked <br /> appropriately,or 2) a complete revised electronic copy of our chemical <br /> 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 nsured that it meets the requirements of <br /> California Health nd Safety Code, Ch pter 6.95, rticle <br /> Business Na C l OE Account 4�1s� <br /> d � <br /> Site Address <br /> Facility Operator/Owner / S� Title l -,�A—' <br /> (PRI <br /> Signature / Date <br />