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`! RECEIVED <br /> !AN 2 8 2002 <br /> a41a. COUNTY OF SAN JOAQUIN �pNcOUNTY <br /> OFFICE OF EMERGENCY SERVICES OAR SERN <br /> m t <br /> ROOM 610,COURTHOUSE DIRECTOR OF <br /> 222 EAST WEBER AVENUE EMERGENCY OPERATIONS <br /> • �,,: {� STOCKTON,CALIFORNIA 95202 <br /> �Iaoa� TELEPHONE(209)468-3962 <br /> HAZARDOUS MATERIALS DIVISION(209)468-3969 <br /> 2002 HAZARDOUS MATERIALS MANAGEMENT PLANANVENTORY <br /> CERTIFICATION STATEMENT <br /> (See Reverse Side for Instructions) <br /> 1. Business Identification Page HMMP Unstaffed Facility Network Attachment, and Facility <br /> Map - Check one box only <br /> A. I1 I certify that there have beentwo changes to the above listed documents since <br /> our business's last update or change was submitted. <br /> B. O I certify that therehas 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/BACVIP (HMMP97.171`3 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 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 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 and. /I,Safety Code, Chapter 6.95, Article 1. <br /> Business Name /.Rl ifh OES Account # (0(4_4� <br /> Site Address <br /> I <br /> Facility Operator/Ow er �j 1 J Q✓\ �Any\1A Tide n <br /> (..NT) , L/ <br /> SignatureAIAXWD Date <br />