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5t4)N COUNTY OF SAN JOAQUIN <br /> aa6 ?� OFFICE OF EMERGENCY SERVICES RONALDE.BALDWIN <br /> ROOM 610,COURTHOUSE DIRECTOR OF <br /> 222 EAST WEBER AVENUE E �v� <br /> • �,. STOCKTON,CALIFORNIA 95202 �1GVG <br /> 4noM� TELEPHONE(209)468-3962 • - �r�M <br /> HAZARDOUS MATERIALS DIVISION(209)468-3969 UC <br /> ;NTY <br /> 2002 HAZARDOUS MATERIALS MANAGEMENT PLANJWVENTORY SMYIGE; <br /> CERTIFICATION STATEMENT <br /> (See Reverse Side for Instructions) <br /> 1. Business Identification Page. HM IP, Unstaffed Facility Network Attachment, and Facility <br /> Map - Check one box only <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 either 1)appropriate revised hard copy forms, or 2) a complete revised <br /> electronic copy of our Business ID Page/HNUVIP (HMMP97.FP3 File) and, if <br /> appropriate, our Unstaffed Attachments (STAFF97.FP3 File) has/have been <br /> transmitted concurrently with this Certification Statement. <br /> 2. Chemical Inventory (Chemical Description Page) - Check one box only <br /> A. '6 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 /> required by Section 11022 of Title 42 of the United States Code. I further <br /> certify that there has been no change in the quantity of any 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 /> appropriately, or 2) a complete revised electronic copy of our chemical <br /> inventory (CHEM97 File)has been transmitted with this Statement. <br /> 3. Environmental Contact E-Mail Address (if available) <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 �Xdo`2 Vy,i'Ged .- OES Account # p <br /> b� <br /> Dc-- <br /> 1 C <br /> Site Address L) / 115- /J J/E 11 , 9 - / <br /> Facility Operator/Owner r ! : GL O✓ Tide frC5 cl 1d— <br /> (PRINT) <br /> Signature Date n 2- <br />