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rinrt tr4-�uus 10:tb INSURANCE SERVICES 209 473 3758 P.01/01 <br /> COUNTY OF SAN JOAQ'UIN <br /> OFFICE OF EMERGENCY SERVICES <br /> t;M Ori 91 `�J <br /> �:.:• �`::�'.. <br /> ROOM eto,COURTHOUSE VEN <br /> 222 EAST WEBER A UE 0 <br /> STOCKTON,CA 95202 <br /> Tr:LL'PrfONC(2ao)46BJ%2 <br /> HAZARDOUS MATERIALS DIVISI0Nt109)4bt-3%4 <br /> MAR 0 4 2003 <br /> 2003 HAZARDOUS MATERIALS MANAGEMENT PLAN AND INVENTOR' SANJ0AUUINC00 <br /> CERTIFICATION STATEMENT FICE <br /> (See Reverse Side for Instructions) OfEMERGENCVSREICE; <br /> 1. Business Identification Page Hazardous Materials Management Plan Facility <br /> Man(s) Certification- Check aox or lI y <br /> 1 certify that there have been no changes to the above listed documents <br /> since our business's last update or change was submitted. <br /> ❑ 1 certify that there hasUten,a change to one or more of the above <br /> documents and that appropriate revised hard copy forms have been <br /> submitted with this Certification Statement. <br /> 2. Certification of Chemical Inventory - Check one box only <br /> / I certify that the information contained in the most recently submitted <br /> / chemical inventory is complete,accurate, up-to-date, and contains the <br /> information required by Section 11022 of Title 42 of the United States <br /> Code. I further certify that there has been no change in the quantity of any <br /> hazardous material reported and that no hazardous materials,are being <br /> handled that are not listed. <br /> O I certify that there has been a change in my chemical inventory since the <br /> last submission and completed hard copies of changed Chemical <br /> Description Pages with "Add","Delete", or"Revised"marked <br /> appropriately have been submitted with this Certification Statement. <br /> I understand that false or inaccurate information may make my company liable In an <br /> emergency. I further certify that I have reviewed the above listed documents and that <br /> the statements checked above constitute an accurate statement. <br /> Business Name I( �u,a.,,-- OES Account# <br /> Site Address Qi ® <br /> Operator/Owner CvC� Title C L e� <br /> Signature /te �/�//Zo43 <br /> ,�nG1j Sc{brrli�,.. <br /> v e y 60 "64�ti <br /> sly /2./16/4 <br /> TOTAL P.01 <br />