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COMPLIANCE INFO
Environmental Health - Public
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EHD Program Facility Records by Street Name
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1900 - Hazardous Materials Program
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PR0519716
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COMPLIANCE INFO
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Entry Properties
Last modified
10/26/2018 1:16:33 PM
Creation date
6/9/2018 8:58:51 PM
Metadata
Fields
Template:
EHD - Public
ProgramCode
1900 - Hazardous Materials Program
File Section
COMPLIANCE INFO
RECORD_ID
PR0519716
PE
1921
FACILITY_ID
FA0009549
FACILITY_NAME
BRUNO PEPPER CO
STREET_NUMBER
11291
Direction
N
STREET_NAME
HAM
STREET_TYPE
LN
City
LODI
Zip
95242-9412
APN
05907010
CURRENT_STATUS
01
SITE_LOCATION
11291 N HAM LN
P_LOCATION
99
P_DISTRICT
004
QC Status
Approved
Scanner
EJimenez
Supplemental fields
FilePath
\MIGRATIONS\H\HAM\11291\PR0519716\COMPLIANCE INFO.PDF
QuestysFileName
COMPLIANCE INFO
QuestysRecordDate
7/24/2017 10:27:20 PM
QuestysRecordID
3527631
QuestysRecordType
12
QuestysStateID
1
Tags
EHD - Public
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1. <br />2 <br />QPQuIN COUNTY OF SAN JOAQUIN <br />OFFICE OF EMERGENCY SERVICES RONALDE: BALDWIN <br />ROOM 610, COURTHOUSE DIRECTOR OF <br />222 EAST WEBER AVENUE EMERGENCY OPERATIONS <br />STOCKTON, CALIFORNIA 95202 <br />TELEPHONE (209) 468-3962 <br />HAZARDOUS MATERIALS DIVISION (209) 468-3969 <br />2002 HAZARDOUS MATERIALS MANAGEMENT PLANANVENTORY <br />CERTIFICATION STATEMENT <br />(See Reverse Side for Instructions) <br />Business Identification Page HMMP Unstaffed Facility Network Attachment, and Facility <br />Map - Check one box only <br />A. ;Wl�- 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/141vW (HNIlvIP97.FP3 File) and, if <br />appropriate, our Unstaffed Attachments (STAFF97.FP3 File) has/have been <br />transmitted concurrently with this Certification Statement. <br />Chemical Inventory (Chemical Description Pagel - Check one box only <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 1. <br />Business Name &Zk it to ?EPPIn?_ � OES Account # <br />Site Address 112 IN, RAVn (-AME- Lobs e_�Fi 95Zy2 <br />Facility Operator/Owner G t gwR 5V-L*D Title i?E`+1L�f}.1 _ <br />Date / 2- ZI-Zo0 / <br />
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