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~ %n rte <br /> r. . Z COUNTY OF SAN JOAQUIN <br /> OFFICE OF EMERGENCY SERVICES MAR I I <br /> RONALD E. BALDWIN <br /> ♦'. .:� ROOM 6I0,COURTHOUSE COORDINATOR _ <br /> 222 EAST WEBER AVENUE <br /> �a�/i P STOCKTON, CALIFORNIA 95202 i <br /> TELEPHONE(209)46$-3962 <br /> HAZARDOUS MATERIALS DIVISION(209)468-3969 <br /> 1998 HAZARDOUS MATERIALS MANAGEMENT PLANANVENTORY <br /> CERTIFICATION FORM <br /> 1. Busine s Identification a e HMMP <br /> onl Unstaffed Facili Network Attachment and Facili <br /> a - heck n Box <br /> A. I certify that there have been no changes to the above listed documents since <br /> our business's last update or change was submitted. <br /> B• ❑ I certify that there has been a change to one or more of the above documents <br /> and that appropriate revised documents are attached to the Certification Form in <br /> accordance with the instructions. <br /> 2. Chemical Invento Chemical Description Pae -_Cheek Box A or <br /> Ln B a lieable Box es <br /> A• I 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) I have attached copies of Chemical Description Pages of chemicals <br /> removed with "delete" marked at the top. <br /> ❑ (2) I have attached a new Chemical Description Page completed in its <br /> entirety for each new chemical and for each chemical with information <br /> that has changed since our last submission. <br /> I certify that the above information is accurate to the best of my knowledge. I understand that <br /> false/inaccurate information may contribute to complications during a hazardous materials <br /> incident and that I may be held liable for those actions. <br /> Business Name .-7 ZL Ve k1 <br /> Site Address ' (o ��,1Jt_wC w - UCS t�� C <br /> Facility Operator/0 �J� r V\V1U Title �, <br /> {PRINT) <br /> Signature Date t <br />