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ANIy. COUNTY OF SAN JOAQUIN <br /> _;• a OFFICE OF EMERGENCY SERVICES RONALD E.BALDWIN <br /> ROOM 610,COURTHOUSE COORDINATOR <br /> 222 EAST WEBER AVENUE <br /> • ..; s` STOCKTON,CALIFORNIA 95202 <br /> TELEPHONE(209)468-3962 <br /> HAZARDOUS MATERIALS DIVISION(209)468-3969 <br /> 1999 HAZARDOUS MATERIALS MANAGEMENT PLANANVENTORY <br /> CERTIFICATION STATEMENT <br /> 1. Business Identification Page. HMMP. Unstaffed Facility Network Attachment and Facility • <br /> Map - 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 Box A or B <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 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.FP3 File) has been transmitted concurrently with this • <br /> Certification 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. <br /> Business Name <br /> Site Address <br /> Facility Operator/Owner Title <br /> (PRIM) <br /> Signature Date <br /> • <br />