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D t L 2 0 2001 <br /> ,sir <br /> „a41n COUNTY OF SAN JOAQUIN ISERVIOES <br /> OFFICE OF EMERGENCY SERVICES RONALD E.6ALDWIN <br /> r` a ROOM 610,COURTHOUSE DIRECTOR OF <br /> u: s <br /> 222 EAST W$$EIt AVENUE EMERGENCY OPERATIONS <br /> STOCKTON,CALIFORNIA 95202 <br /> TELEPHONE(209)468-3962 <br /> HAZARDOUS MATERIALS DIVISION(209)468-3969 <br /> 2002 HAZARDOUS MATERIALS MANAGEMENT PLANIINVENTORY <br /> CERTIFICATION STATEMENT <br /> (See Reverse Side for Instructions) <br /> 1. Business Identification Paee HMMP Unstaffed Facility Network Attachment. and Facility <br /> Map - Check one box only <br /> A. %1I 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 PageADESAIP (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 Inventory (Chemical Description Pagel - Check one box only <br /> A. El 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 githe 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 ensured that it meets the requirements of <br /> California Health and Safety Code, Chapter 6.95, Article 1. <br /> Business Name EEPEN1RE NB y MEG RC OES Account# 621 <br /> Site Address 1111 S. Si0QC1CN SIIt1EC LCEE, CA. 95240 <br /> Facility Operator/Owner CLIFF ISE Title <br /> (PRINT) <br /> PRESIIX�PIP <br /> - <br /> Signature �0.� � '" `-� r�� Date 2-r/,P <br />