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HAZARDOUS MATERIALS BUSINESS PLAN CERTIFICATION FORM For Use by Unidocs Member Agencies or where approved by your Local Jurisdiction Authority Cited: RECEIVED Health and Safety Code§25503.3(c); 19 CCR§2729.5(c) To: Agency Name: San Joaquin Cty Env Health AUG 0 6 Nil Agency Mailing Address: 304 E. Weber Avenue, Third Floor Er. RO m rsNTAi HEALTH Stockton, CA 95202 PERMIT/SERVICES Pursuant to Section 25503.3(c) of California Health and Safety Code (HSC), the Hazardou terials Business Plan (HMBP) certification described below is hereby submitted for the following fac ' r%r-. Facility Name: CRLLC/76 #5447 AUG 2 S 201, zi Facility Street Address: 1469E HAMMER LN City: STOC FFA,,-, rem . r Date of Current HMBP: 08/01/2011 0YS%V/Cf3 I certify that: (Check the appropriate box.) ❑ I have personally reviewed the Hazardous Materials Bu siness Plan currently on file with your agency and certify that the HMBP is complete and accurate. (See bottom of page for details) If this facility is subject to Federal Emergency Planning and Com munity Right to Know Act(EPCRA) reporting requirem ents, I have submitted the following documents with this Certification Form: Unified Program Consolidated Form (UPCF) Business Activities page; UPCF Business Own er/Operator Identification page with current signature and date; Hazardous Materials Inventory Statement page(s)with an original signature,photocopy of an original signature, or signature Stam p on each page for all Extremely Hazardous Substances (EHS) handled at or above their Federal Threshold Planning Quantity(TPQ) or 500 pounds,whichever is less. or ® Revisions to the Hazardous Materials Business Plan are necessary. The HMBP as revised is complete and accurate and is being im plemented. A copy of the revisions has been electronically subm itted or is enclosed with this Certification along with a signe d UPCF Business Owner/Operator Identification page and UPCF Business Activities page if the HMBP re vision include changes to the Hazardous Materials Inventory Statement. OWNER/OPERATOR CERTIFICATION: I hereby certify under penalty of law that, based upon my inquiry of those individuals responsible for obtaining the information reported above, I believe that the submitted information is true, accurate, and complete. I understand that a revised HMBP must be submitted within 30 days of any change in this facility's storage or handling of hazardous materials that would require updating of the HMBP. Name of Owner/Operator (Print): Allen Faass Title: California Compliance Mgr. Phone: (925) 884-0800 Signature: ZY'a �i Date: �S By checking the upper box on this form,you are certifying that: • The information contained in the HMBP most recently submitted is complete,accurate,and up-to-date;and • There has been no change in the quantity of any hazardous material as reported in the most recently submitted Hazardous Materials Inventory forms;and • The facility has not begun handling any hazardous material in a HMBP reportable quantity that is not currently listed in the Hazardous Materials Inventory;and • The most recently submitted HMBP contains the information required by Section 11022 of Title 42 of the United States Code;and • There have been no substantial char es in the facili 's operations that would require revision of the current HMBP. UN-039-1/1 www.unidocs.org Rev.10/09/07