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C <br /> RECEIVED <br /> FEER I <br /> apR4!.M, COUNTY.OF SAN JOAQUIN _ 1510IJ0AMINCUUNIy <br /> r: OFFICE OF EMERGENCY SERVICES O��MOYtS WCEs <br /> ROOM 610,i:UUttt HOUSE DIRECTOR OF <br /> 222 EAST WEBER AVENUE EMERGENCY OPERATIONS <br /> e*t)Poa' STOCKTON,CALIFORNIA 95202 <br /> TELEPHONE(209)468-3962 <br /> HAZARDOUS MATERIALS DIVISION(209)468-3969 <br /> 2002 HAZARDOUS MATERIALS MANAGEMENT PLAN/INVENTORY <br /> CERTIFICATION STATEMENT <br /> (See Reverse Side for Instructions) <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 either 1)appropriate revised hard copy forms, or 2) a complete revised <br /> electronic copy of our Business ID Page/Hly MP (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 Pagel - Check one box ons <br /> A. 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—_T L o Zid l -jk- leA51-1 OES Account# <br /> Site Address t ri-1 60 N . E68'b Nil) PsA LbckeVrA �C as gl.LN I -L <br /> Facility Operator/Owner a Ft L_ x-A cLJ_n ki:_ _ -- <br /> Signature qsk aP Date 1' PLOZ- <br /> RECEIVE]) DEC 0 4 200 <br />