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x <br /> I <br /> Uzi <br /> COUNTY OF SAN JOAQUIN s�'1[�OFFICE OF EMERGENCY SERVICES RONALD E. BALDWIN <br /> ROOM 61Q COURTHOUSECODROINATOR'222 EAST WEBER AVENUESTOCKTON, CALIFORNIA 95202 <br /> TELEPHONE(203)466-3362 <br /> HAZARDOUS MATERIALS DIVISION[(209)46B.3969 <br /> 1998 HAZARDOUS MATERIALS MANAGEMENT PLAN/INVENTORY <br /> CERTIFICATION FORM <br /> I. Business Identification Page.HMMP. Unstaffed Facilijy Network Attachment.and Facility <br /> Map - Check one Box only <br /> A. I certify that there have been n. Q 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 Inventory (Chemical Description Page) - Check Box A or applicable Box(es) <br /> in B <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) 1 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 'S -1 - t:-6-t�E .0G -- . <br /> Site Address L (0 S-l(f k 7 0O <br /> Facility Operator/0 a Title V t+[01,1 V1rQ.t�t <br /> (PRINT) <br /> Signature �r�� Date Z <br />