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COUNTY OF SAN JOAQUIN <br /> OFFICE OF EMERGENCY SERVICES RONALD E.BALDWIN <br /> ROOM 610,COURTHOUSE DIRECTOR OR <br /> 222 EAST WEBER AVENUEreq, �! E OPERATIONS <br /> STOCKTON,CALIFORNL- --202 F;2: °— <br /> TELEPHONE(209)468-3962 <br /> HAZARDOUS MATERIALS DIVISION(209)468-3969 AN 13 2003 <br /> 2003 HAZARDOUS MATERIALS MANAGEMENTji� 1LE' <br /> CERTIFICATION STATEMENT <br /> (See Reverse Side for Instructions) <br /> 1. Business Identification Page HMMP Unstaffed Facility Network Attachment, and Facility <br /> Man - 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/HMMP (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 Page) - 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 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 our last <br /> chemical inventory was submitted and either 1) complete 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.FP3 File) has been transmitted concurrently with this <br /> Certification Statement. <br /> 3. Environmental Contact E-Mail Address (if available): pam ruesgaAconocophillips.com <br /> I understand that false/inaccurate information may make my company liable in an emergency. I further certify <br /> that I have reviewed the above listed documents and information and information contained in the most recently <br /> submitted chemical inventory and have ensured that is meets the requirements of California Health and Safety <br /> Code,Chapter 6.95,Article 1. 2 <br /> Business Name Nick's 76#2611195 OES Account# 309© <br /> Site Address 16500 Louise Ave Lathrop CA 95330) <br /> Facility Operator/Owner)( 'K, h g & TitleX 0 +� <br /> ( <br /> Signatur9� DateX /Z��7 <br />