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COUNTY OF SAN JOAQUIN <br /> :1 OFFICE OF EMERGENCY SERVICES <br /> - x 2101 E. EARHART AVENUE,SUITE 300 ff <br /> ` 1 STOCKTON,CA 95206 <br /> 1" TELEPHONE(209)953-6200 <br /> FAX(209)953-6268 <br /> Q� <br /> 2012 HAZARDOUS MATERIALS MANAGEMENT PLAN AND INVENTORY <br /> CERTIFICATION STATEMENT <br /> (See Reverse Side for Instructions) <br /> 1. Business Identification Pae Hazardous Materials Management flan Facility <br /> f Map(s) Certification - Check one box onl <br /> ❑ 1 certify that there have been no changes to the above listed documents <br /> since our business' last update or change was submitted. <br /> f ❑ I certify that there has been a change to one or more of the above <br /> documents and that appropriate revised hard copy forms have been <br /> submitted with this Certification Statement. .. <br /> 2. Certification of Chemical Inventor - Check one box only <br /> ❑ 1 certify that the information contained in the most recently submitted <br /> i chemical inventory is complete, accurate, up-to-date, and contains the . <br /> information required by Section 11022 of Title 42 of the United States <br /> Code. I further certify that there has been no change in the quantity of any <br /> 1 hazardous material reported and that no hazardous materials are being <br /> a <br /> handled in regulated quantities that are not listed.. „ <br /> 1 ❑ I certify that there has been a change in my chemical inventory since the <br /> C last submission and completed hard copies of changed Chemical <br /> Description Pages with "Add", "Delete", or "Revised" marked <br /> appropriately have been submitted with this Certification Statement. <br /> I understand that false or inaccurate information may make my company liable in an <br /> emergency. I further certify that I have reviewed the above listed documents and that <br /> r <br /> the statements checked above constitute an accurate statement. <br /> Business Name P *I r OES Account # 1306,69_ <br /> Site Address <br /> Operator/Owner Title <br /> r <br /> Signature <br /> Date <br /> w <br /> f <br />