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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 DIVISION (209) 468-3969 <br />REOEIVED <br />JAN 21 M03 <br />bN11*W1VAUffl UUU141 Y <br />OF EMERGENCY bERNE <br />2003 HAZARDOUS MATERIALS MANAGEMENT PLAN AND 1NVENT01t1' <br />CERTIFICATION STATEMENT <br />(See Reverse Side for Instructions) <br />Business Identification Page Hazardous Materials Management Plan Facilitv <br />Mans) Certification - Check one box only <br />60 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 />le 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 43�ry '-kV �4� 41 C,4—y OES Account # ZQn`?'7 <br />Site Address 44S:2s MAGI rl L _5tbCkI&& (-A 0% <br />OperatorA)wrn <br />Signature <br />Title 1&46.6K <br />Date / O-�> <br />