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oPo.H!n <br /> � COUNTY OF SAN JOAQUIN <br /> c 'a OFFICE OF EMERGENCY SERVICES RONALD E. BALDWIN <br /> C Roo.610.couI us[ c00RO1NATOR <br /> 222 EAST WEBER AVENUE <br /> • c _. w • STOCKTON. CALIFORNIA 95202 <br /> 4CIFO0.a TEt NE(209)46&3962 <br /> MAIAR90US MAT 1^"DNISION(209)4643969 <br /> 1998 HAZARDOUS MATERIALS MANAGEMENT PLAN/INVENTORY <br /> CERTIFICATION FORM <br /> 1. Business Identification Page HMMP 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 appropriate revised documents are attached to the Certification Form in <br /> accordance with the instructions. <br /> 2. Chemical Inventory (Chemical Description Pam - Check Box A or applicable Box(esl <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) 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 <br /> Site Address <br /> Facility Operator/Owner Title <br /> �rRum <br /> Signature Date <br />