Laserfiche WebLink
COUNTY OF SAN JOAQUIN <br />OFFICE OF EMERGENCY SERVICES RONALD E. BALDWIN <br />ROOM 610, COURTHOUSE COORDINATOR <br />222 EAST WEBER AVENUE <br />STOCKTON, CALIFORNIA 95202 <br />TELEPHONE (209) 468-3962 <br />HAZARDOUS MATERIALS DIVISION (209) 468-3969 <br />1996 HAZARDOUS MATERIALS MANAGEMENT PLAN/INVENTORY <br />CERTIFICATION FORM <br />1 . Hazardous Materials Management Plan <br />A. ❑ 1 certify that there have been no changes to the Hazardous Materials <br />Management Plan (HMMP) since the last HMMP or HMMP update was <br />submitted. <br />B. ® I certify that there has been a change to the HMMP and updated <br />sections are attached to the Certification Form in accordance with the <br />instructions. <br />2. Chemical Inventor <br />A. IN I certify that the last chemical inventory submitted to the Office of <br />Emergency Services has not changed. <br />B. I certify that there has been a significant change since the last <br />chemical inventory was submitted and that: <br />❑ (1) 1 have listed chemicals deleted from our inventory on the back of <br />the Certification Form. <br />❑ (2) 1 have attached a 1996 Chemical Inventory Form(s) showing <br />new chemicals or significant quantity changes to the <br />Certification Form. <br />I declare under the penalty of perjury that the above information is accurate to the best of <br />my knowledge. I understand that false/inaccurate information may contribute to <br />complications during a hazardous materials incident and that I may be held liable for those <br />actions. <br />Business Name Grant Line Shell <br />Site Address 2375 W. Grant Line Road <br />Facility Manager/ ner Carl ox Title Dealer <br />(PRINT) 6 / <br />Signature Date:V <br />Name of Person Ro ert H. Lee k Assoc.,Environmental Del2t. Title Protect Manager <br />RESPONSIBLE FOR THE C ION OF THE MP (PRINT) <br />Signature 4�7 Date December 11. 1995 <br />