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li •K <br /> yaw h COUNTY OF SAN JOAQUIN <br /> OFFICE OF EMERGENCY SERVICES RONALD E.BALDWIN <br /> ?� ROOM 610,COURTHOUSE DIRECTOR OF <br /> 222 EAST WEBER AVENUE `— <br /> �` { „ STOCKTON,CALIFORNIA 95202 <br /> �Icda' TELEPHONE(209)468-3962 <br /> HAZARDOUS MATERIALS DIVISION(209)468-3969 DEC 2 7 2001 <br /> 2002 HAZARDOUS MATERIALS MANAGEMENT PLA SERVICE' <br /> CERTIFICATION STATEMENT <br /> (See Reverse Side for Instructions) <br /> Business Identification Page FIMMP Unstaffed Facility Network Attachment and Facility <br /> Map -- C,hheck one box only <br /> A. }� I certify that there have been no changes to the above listed documents since <br /> Y ` 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/FHVIMP (HMMP97.FP3 File) and, if <br /> appropriate, our Unstaffed Attachments (STAFF97.FP3 File) has/have been <br /> transmitted concurrently with this Certification Statement. <br /> Chemical Invento Chemical Description Pae - Check one box oni <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 /> 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 I. <br /> Business Name VALLEY FORKLIFT OES Account #605220 <br /> Site Address X <br /> UA <br /> 0Facility Operator/Ow ne Title <br /> ImiNn ) <br /> g <br /> tnature <br /> �' Date <br />