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COMPLIANCE INFO_PRE 2019
Environmental Health - Public
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1900 - Hazardous Materials Program
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PR0519809
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COMPLIANCE INFO_PRE 2019
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Entry Properties
Last modified
2/1/2019 11:18:15 AM
Creation date
6/9/2018 1:37:58 PM
Metadata
Fields
Template:
EHD - Public
ProgramCode
1900 - Hazardous Materials Program
File Section
COMPLIANCE INFO
FileName_PostFix
PRE 2019
RECORD_ID
PR0519809
PE
1921
FACILITY_ID
FA0002541
FACILITY_NAME
7-ELEVEN INC #20632
STREET_NUMBER
4627
STREET_NAME
DA VINCI
STREET_TYPE
DR
City
STOCKTON
Zip
95207
APN
11002003
CURRENT_STATUS
01
SITE_LOCATION
4627 DA VINCI DR
P_LOCATION
01
P_DISTRICT
002
QC Status
Approved
Scanner
EJimenez
Supplemental fields
FilePath
\MIGRATIONS\D\DA VINCI\4627\PR0519809\COMPLIANCE INFO.PDF
QuestysFileName
COMPLIANCE INFO
QuestysRecordDate
11/9/2015 7:04:30 PM
QuestysRecordID
2916955
QuestysRecordType
12
QuestysStateID
1
Tags
EHD - Public
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. RECEIVED - <br /> D E C 2 4 2001 <br /> x4�a �o COUNTY OF SAN JOAQUIN . S1il11dOH:;;��� 1!lflliY <br /> t: .2 OFFICE OF EMERGENCY SERVICES gig <br /> ROOM 610,CO[TRTHOIJSE t .Y ,DIRECTOR OF <br /> s 222 EAST WEBER AVENUE EMERGENCY OPERATIONS <br /> l�Qyi� <br /> c`4•.•, ;P STOCKTON;CALIFORNIA 95202 REOE VED <br /> L <br /> TELEPHONE(209)468-3962 <br /> HAZARDOUS MATERIALS"DIVISION(209)468-3969 <br /> i 'JAN 1 4,2002 <br /> *.. 2002 HAZARDOUS MATERIALS MANAGEMENT PLAN/INVENT6* Yj(jUlCdy <br /> CERTIFICATION STATEMENT oFRCEOFEMERGENCYSEFMCEs <br /> .(See Reverse Side for : Instructions) 4 <br /> 1. Business Identification Page, HMMP Unstaffed Facility Network Attachment and Facilit <br /> ,Map - Check Check one box only <br /> A. ,I certify that there have been no changes to the above listed documents since <br /> • � �=— �- ::: 2.00_i'busine_ss's lasf.'update or chaise was submitted ;' x <br /> B. "° U. 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/FWMP (I-MMP97.FP3 File) and, if <br /> appropriate, our Unstaffed Attachments (STAFF97.FP3 File) has/have been <br /> transmitted concurrently with this Certification Statement. <br /> 2. t Chemical Invento Chemical Description Pae -Check one boxonl <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 /> A.. required by Section 11422'of'Title 42 of the United States"Code. I further <br /> t <,Y certify that there has been no change in the quantity of aby'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 /> k appropriately, or 2) a complete revised electronic copy of our chemical <br /> inventory (CHEM97 File)has been transmitted with this Statement. <br /> 3�- -'.: .-1 nvironTnumal-C-'umact-E--Mai"1-Address-(ifavailab - <br /> ,• 't_ - - ,�- ate';,r . .,� `�: - - ^�; a.�,-w.v,-.-� ..r.-= :,a-,a..,P��+"+,.,..••.�wL? r"�:4:fir-^ -'�'� <br /> r <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 / rum 7172-0 7J OES Account# Sd I <br /> Site Address Z DP4- f 4 L( <br /> r;,Bob DeNirino;. . - :' Environmental:Manager <br /> Facility Operator/Owner r- Title <br /> :.. <br /> r. Signature Date Z u,X�Z� <br />
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