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OP�U'I N; C <br /> COUNTY OF SAN JOAQUIN <br /> a' Z< OFFICE OF EMERGENCY SERVICES,;-�( ---__=-_N.��o E. 9ALOW IN <br /> N: G` <br /> ROOM 610.COURTHOUSE 'Y r COOQDIN^TOF <br /> 222 EAST WEBER AVENUE 1. <br /> cq. �P • STOCKTON. CALIFORNIA 95202 n51 I l+ '' <br /> �(FORa TELEPHONE(209)468-3962 'V i JAN �. <br /> 1 5 1998 <br /> HAZARoous MATERIALS MvlsloN(209)4683969 <br /> 1998 HAZARDOUS MATERIALS MANAGEMENT PLANANVENTORY <br /> CERTIFICATION FORM <br /> 1. Business Identification Page, HMMP Unstaffed Facility Network Attachment. and Facility <br /> Ma - 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 appropriate revised documents are attached to the Certification Form in <br /> accordance with the instructions. <br /> 2. Chemical Inventory (Chemical Description Pagel - Check Box A or applicable Box(es) <br /> in B <br /> A. Cv/I certify that the last chemical inventory submitted to the Office of Emergency <br /> Services has not changed. <br /> B. I certify that there has been a significant change since the last chemical <br /> inventory was submitted and that: <br /> ❑ (1) I have attached copies of Chemical Description Pages of chemicals <br /> removed with "delete" marked at the top. <br /> ❑ (2) I have attached a new Chemical Description Page completed in its <br /> entirety for each new chemical and for each chemical with information <br /> that has changed since our last submission. <br /> I certify that the above information is accurate to the best of my knowledge. I understand Ithat <br /> false/inaccurate information may contribute to complications during a hazardous materials <br /> incident and that I may be held liable for those actions. <br /> Business Name x 4,PrZ1111 <br /> Site Addressed/ 74 1 <br /> Facility Operator/vwner� / //t ��/ <br /> Title <br /> IPRIMI ��,�p,( <br /> Sig azure �V/ v Date <br />