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REOEIVED JAN 17 2002 �� ..h. COUNTY OF SAN JOAQUIN OFW OFBOGENCYS RE LACES OFFICE OF EMERGENCY SERVICES RONALD R.BALDWIN 3 ROOM 610,COURTHOUSE DIRECTOR OF 222 EAST WEBER AVENUE EMERGENCY OPERATIONS • c.., STOCKTON,CALIFORNIA 95202 �ticoP� TELEPHONE(209)468-3962 HAZARDOUS MATERIALS DIVISION(209)468-3969 2002 HAZARDOUS MATERIALS MANAGEMENT PLAN/INVENTORY CERTIFICATION STATEMENT (See Reverse Side for Instructions) 1. Business Identification Page, FIMMP, Unstaffed Facility Network Attachment. and Facility Map - Check one box only A. Uy" I certify that there have been no changes to the above listed documents since our business's last update or change was submitted. B. ❑ I certify that there has been a change to one or more of the above documents and that either 1) appropriate revised hard copy forms,or 2) a complete revised electronic copy of our Business ID Page/BMMP(HMW97.FP3 File) and,if appropriate, our Unstaffed Attachments (STAFF97.FP3 File) has/have been transmitted concurrently with this Certification Statement. 2. Chemical Inventory (Chemical Description Page) - Check one box only A. UJr I certify that the information contained in the most recently submitted chemical inventory is complete, accurate, up-to-date, and contains the information required by Section 11022 of Title 42 of the United States Code. I further certify that there has been no change in the quantity of any hazardous material reported and that no hazardous materials are being handled that are not listed. B. ❑ I certify that there has been a change in our chemical inventory since the last chemical inventory was submitted and either t)completed hard copies of Chemical Description Pages with "Add", "Delete", or"Revised' marked appropriately,or 2) a complete revised electronic copy of our chemical inventory (CHEM97 File)has been transmitted with this Statement. 3. Environmental Contact E-Mail Address (if available) oh*ty j� Qu i kXke-c.0 1 I understand that false/inaccurate information may make my company liable in an emergency. I further certify that I have reviewed the above listed documents and information contained in the most recently submitted chemical inventory and have ensured that it meets the requirements of California HealthandSafety Code, Chapter // 6.95, Article 1. Business Name �L . �c 9-4p 174*e e&4 4"',37 OES Account# Site Address 228'S' ogr4F2�usD J�c�7�2tET� AC)<,h,0 cR / 9'SIZI�S n Facility Operator/Owner 4j V KASF �w�Q�(�u�/9 s�Title f5i gdo4(scEr (PRINT) Signature Date