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COUNTY OF SAN JOAQUIN <br />OFFICE OF EMERGENCY SERVICES RONALD L BALDWIN <br />W. ROOM 610, COURTHOUSE COORDINATOR <br />222 EAST WEBER AVENUE <br />STOCKTON, CALIFORNIA 95202 <br />TELEPHONE (209) 469-3962 <br />HAZARDOUS MATERIALS DIVISION (209) 468-3969 <br />1996 HAZARDOUS MATERIALS MANAGEMENT PLAN/INVENTORY <br />CERTIFICATION FORM <br />1. Hazardous Materials Management Plan (Check one box onlv <br />A. a I certify that there have been no changes to the Hazardous Materials <br />t1- <br />Management Plan (HMP) sincethelast HMMP or H update was <br />submitted. <br />B . 0 1 certify that there has been a change to the BA4MP and updated sections are <br />attached to the Certification Form in accordance with the instructions. <br />2. Chemical Inventory (Check Box A or npropriate box(es) in B) <br />A. 8 1 certify that the last chemical inventory submitted to the Office of Emergency <br />Services has not changed. <br />B . I certify that there has been a significant change since the last chemical <br />inventory was submitted and that: <br />❑ (1) 1 have listed chemicals deleted from our inventory on the 1996 <br />Chemical Inventory Deletion Form. <br />0 (2) 1 have attached a 1996 Chemical Inventory Fpm( -s- A -Sowing new <br />chemicals or significant quantity changes to the Certification Form. <br />I declare under the, penalty of perjury that the above information is accurate to the best of my <br />knowledge. I understand that false/in accurate information may contribute to complications during <br />a hazardous material incident and that I may be held liable for those actions. <br />Business Name RP OtL EACUXT�/- A 01+7(0 <br />Site Address 1q50 WE'4D—T S'TQE(-'T' IV -A,014 , C -A R5,37 ('- <br />Facility Manager/Owner DEMSE, WRIT.� Title <br />Date 1-1#44- <br />