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i6l. COUNTY OF SAN JOAQUIN P :n'0 <br /> OFFICE OF EMERGENCY SERVICES <br /> ROOM 610,COURTHOUSE JAN AN3M4 <br /> cl 222 EAST WEBER AVENUE g�ryJF <br /> ,.r STOCKTON,CA 95202 ffr.E <br /> TELEPHONE(209)468-3962 PN1(iE <br /> { }1` HAZARDOUS MATERIALS DIVISION(209)468-3969 <br /> 2004 HAZARDOUS MATERIALS MANAGEMENT PLAN AND INVERQO2Yr <br /> CERTIFICATION STATEMENT <br /> (See Reverse Side for Instructions) JAN 13 2014 <br /> SAS JUF',(2UIN L'U!IP7IY <br /> 1. Business Identification Page, Hazardous Materials Management Plan, Facit <br /> Map(s) Certification - Check one box only <br /> I 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 /> 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 or inaccurate information may make my company liable 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 Name O�E2yS Account# _I ©3�� <br /> Site Address S �� 1� 9 7 /tc A w! yn q s <br /> Operator/Owner V IN OL104NfR-Title <br /> Signature Date ?-YAP <br />