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FEB 19 2004 11 : 10AM HP LASERJET 3200 P. 1 <br /> ,��),n•, COUNTY OF SAN JOAQUIN <br /> FEB 19 2004 <br /> i" OFFICE OF EMERGENCY SERVICES <br /> ROOM 610,COURTHOUSE <br /> i i ! 222 EAST WEBER AVENUE <br /> STOCKTON,CA 95202 <br /> •,c y,,• TELEPHONE(209)468.3962 <br /> HAZARDOUS MATERIALS DIVISION(209)468-3%9 <br /> 2003 HAZARDOUS MATERIALS MANAGEMENT PLAN AND INVENTORY <br /> CERTIFICATION STATEMENT <br /> (See Reverse Side for Instructions) <br /> I. Business Identification Page. Hazardous Materials Management Plan, Facility <br /> Man(s) Certification- Check one box only <br /> 1 certify that there have been no changes to the above listed documents <br /> since our business's last update or change was submitted. - - - <br /> ❑ I 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. Certification of Chemical Inventory-Check one box only <br /> )9( 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 urinaccurate information may make my company Gable in an <br /> emergency. I further certify that I have reviewed the above listed documents and that <br /> the statements checked above constitute an accurate statement. <br /> Business Narne A wo OES Account# <br /> Site Address 2250 S—RNAPJ_ Iq It _570&7Y4 (!A- q5&5 <br /> Operator/Owner Ii Lz.E— Title 0e, l ag <br /> Signature Date <br />