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1900 - Hazardous Materials Program
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PR0520990
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COMPLIANCE INFO
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Entry Properties
Last modified
11/22/2024 4:00:54 PM
Creation date
8/7/2018 10:46:25 AM
Metadata
Fields
Template:
EHD - Public
ProgramCode
1900 - Hazardous Materials Program
File Section
COMPLIANCE INFO
RECORD_ID
PR0520990
PE
1919
FACILITY_ID
FA0002469
FACILITY_NAME
KFC CORBIN 255
STREET_NUMBER
4455
STREET_NAME
PACIFIC
STREET_TYPE
AVE
City
STOCKTON
Zip
95207-7601
CURRENT_STATUS
01
SITE_LOCATION
4455 PACIFIC AVE
P_LOCATION
01
QC Status
Approved
Scanner
EJimenez
Tags
EHD - Public
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COUNTY OF SAN JOAQUIN <br />OFFICE OF EMERGENCY SERVICES <br />ROOM 610, COURTHOUSE <br />222 EAST WEBER AVENUE <br />STOCKTON, CA 95202 <br />TELEPHONE (209) 468-3962 <br />HAZARDOUS MATERIALS DMSION (209) 468-3969 <br />DECEIVED <br />APR 112005 <br />SAN JOAQUIN COUNTY <br />OFFICE OF EMERGENCY SERVICES <br />2005 HAZARDOUS MATERIALS MANAGEMENT PLAN AND INVENTORY <br />CERTIFICATION STATEMENT <br />(See Reverse Side for Instructions) <br />Business Identification Page, Hazardous Materials Management Plan, Facility <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 C, OES Account # 1 ar I <br />Site Address <br />Operator/Owner �1 fl,)A(S) (r Title AGJILX � Owfi�r <br />Signature Date `� l <br />
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