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FES-11-02 MON 03.23 FM FAX NO r, Ue <br /> WWII, .1 RECEIVED <br /> F E a 1 1 2W2 <br /> COUNTY OF SAN JOAQQUIN 8MJ0Auuwu:0UNTy <br /> OFFICE OF EMERGENCY SERVICES RoaAi�NCYSEflVICES <br /> r' s FEW, molo,tnURTliousm mIRLMROF <br /> 222 EAST WIID6R AVL'NUL 6rnkRr.,w,.r R+n.l <br /> S'MCNTON,CALIFORNIA 95202- <br /> TELEPHONE <br /> 5202TELEPHONE(200).169•700I <br /> IIAZARDOus MATIARLUX DIVISION(2001 469 1060 <br /> 2002 HAZARDOUS MATERIALS MANAGEMENT PLAN/INVENTORY <br /> CERTIFICATION STATEMENT <br /> (Sae Reverse Side for Instructlonc) <br /> 1. Badness Identification Pte,HMMP.Unstaff. Facilily Network Attachmont.and Fl ility <br /> MQ - Check one box only <br /> A. I certify that tiscre have been qg changes to the above listed documents sines <br /> our business's last update or change was submitted. <br /> B. Cl I certify that there has been a chaagc it,our ur murc or 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(I'IMW97,FP3 File)and,it <br /> appropriate,Our Unstaffed Attacluucnis(STAFF977P3 pile)hasihave bten <br /> transmitted concurrently with this Certification Statement. <br /> 2. Qigjuicul Inventory (Chemical Desuiyliun Pare)- Check one box only <br /> A. � I certify that the information contained in the most recently submitted ehemieul <br /> inventory is complete,accurate,up-to-date,and contains the information <br /> required by Section 11022 of'h'tle 42 of the United States Code. I further <br /> certify that there has bun no change in the quantity of any hazardous material <br /> rep01TC0 and that no hazardous materials are being handled that are not hstod. <br /> B. U I certify that there{1a en a change in our chemical inventory since the last <br /> chemical inventory was submitted and s1W 1)completed hard copies of <br /> Chenucal Description Pages with"Add","Delete",or"Revised"marked <br /> appropriately',or 2)a complete revised electronic copy of our chemical <br /> inventory (CMM97 File)has been transmitted with this Statement, <br /> 3. Environmental Contact E-Mail Addtess fif available) - t<Lnna x&I . 1� Y�SUll 1 CeS. <br /> 1 understand that falselinaccurate information may make my company liable in an emergency. 1 <br /> further txrtiry that 1 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 6.93, Article 1. <br /> ` <br /> Business Nams�� C � t�e,',�(t�.�� �(ry'�v� (✓ OES Aee(ou�nt N 1 D WZ q ��'T-' <br /> SitcAddre>;; � �AcizeI�CII�. C'YV� „ `��ock�-tlt� 1J"sp3 <br /> Facility Operator/Owner_ . Le p � \ <br /> Signuturc�� ` Date D <br /> z 'd 0092-83*-BOL S30 uTnbeor ues e92tTT 20 IT qad <br />