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REOEIVED <br /> COUNTY OF SAN JOAQUIN U t U 2 4 Cuu i <br /> OFFICE OF EMERGENCY SERVICES Rcbv4ftABa6uw00" <br /> aQ e�..oma <br /> u '=i ROOM 610,COURTHOUSE ()F'EPfWK"v WO� y <br /> 222 EAST WEBER AVENUE EMERGENCY OPERATIONS <br /> c.,.. v STOCKTON,CALIFORNIA 95202 <br /> 4tlFaa`' TELEPHONE(209)468-3962 <br /> HAZARDOUS MATERIALS DIVISION(209)468-3969 <br /> 2002 HAZARDOUS MATERIALS MANAGEMENT PLAN/INVENTORY <br /> CERTIFICATION STATEMENT <br /> (See Reverse Side for Instructions) <br /> 1. Business Identification Page HMMP Unstaffed Facility Network Attachment. and Facility <br /> Map - 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 either 1) appropriate revised hard copy forms, or 2) a complete revised <br /> electronic copy of our Business ID Page/H1 WP (HNIMP97.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 Invents (Chemical Description Pagel - 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��w�t7l <br /> ment. <br /> 3. Environmental Contact E-Mail Address (if available) NP 7—JA Cdn <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 7- L' q0 k CES Account# <br /> Site Address / / 5� 4✓ ��� 7� / <br /> r3 b� V 1 – e I"e— itle � IM <br /> . <br /> Facility Operator/Owner /✓I✓yo <br /> 4 (PRINT) <br /> /�--- Date <br /> Signature l <br />