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RECEIVE® <br /> JAN 15 2002 <br /> 81 <br /> INGOUNfy <br /> a h. COUNTY OF SAN JOAQUIN OpMpJUAUUgENCYSERVICES <br /> OFFICE OF EMERGENCY SERVICES RONALD E.BALDWIN <br /> r.' <br /> ROOM 610,COURTHOUSE DIRECTOR OF <br /> a: < <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 PLAN/INVENTORY <br /> CERTIFICATION STATEMENT <br /> (See Reverse Side for Instructions) <br /> 1. Business Identification Page, HNEVIP- Unstaffed Facility Network Attachment, and Facility <br /> MaD - 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 /> l� and that either 1) appropriate revised hard copy forms, or 2) a complete revised <br /> electronic copy of our Business ID Page/BACYIP (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. 97 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 <br /> Statement. <br /> 3. 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 /a/n�d Safety Code,, Chapter 6.95, Article 1. <br /> Business Name / r7b A,*��I1867/ QOESS Account#370 <br /> Site Address /0(/Q �lil56o ou <br /> L,F�LlISL TlV1J � 1 / 1 T J <br /> Facility Operator/Owner*4 /V-/c 4,)r 'a Titlek 40'"u <br /> IPRIMI <br /> Signature * Date I /7/Z°fl2 <br />