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l.r ..t <br /> COUNTY OF SAN JOAQUIN RECEIVED <br /> OFFICE OF EMERGENCY SERVICES <br /> *} ROOM 610,COURTHOUSE DEC - 5 2002 <br /> w. {I 222 EAST WEBER AVENUE , <br /> STOCKTON,CA 95202 MEOFEMERGENC/ac8V1C:- <br /> `.rc „ TELEPHONE(209)468-3962 <br /> i HAZARDOUS MATERIALS DIVI S[ON(209)468-3969 <br /> 2003 HAZARDOUS MATERIALS MANAGEMENT PLAN AND INVENTORY <br /> CERTIFICATION STATEMENT <br /> (See Reverse Side for Instructions) <br /> 1. Business Identification Pape, Hazardous Materials Management Plan Facility <br /> May(s) Certification - Check one box only <br /> ® I certify that there have been no changes to the above listed documents <br /> since our business's last update or change was submitted. <br /> ❑ 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 Inventory - Check one box only <br /> X I certify that the information contained in the most recently submitted <br /> 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 /> hazardous material reported and that no hazardous materials are being <br /> handled that are not listed. <br /> ❑ I certify that there has been a change in my chemical inventory since the <br /> 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 /> the statements checked above constitute an accurate statement. <br /> Business Name �oo% dee r OES Account# <br /> Site Address 2 & :5-4 6). 0#e-c A_ // <br /> Operator/Owner DX e r- ttt �rs Title �Gti 7'/h e <br /> Signature Date A Z <br /> T T <br />