Laserfiche WebLink
C/ 40 00 RECEIVED <br /> 0 E C 10 2001 <br /> 4Q4 y COUNTY OF SAN JOAQUIN AW <br /> OFFICE OF EMERGENCY SERVICES RONALDE.BALDWIN SERVICES <br /> u '=i ROOM 610,COURTHOUSE DIRECTOR OF <br /> 222 EAST WEBER AVENUE EMERGENCY OPERATIONS <br /> • r... STOCKTON,CALIFORNIA 95202 <br /> 7I%FOAL TELEPHONE(209)468-3962 <br /> HAZARDOUS MATERIALS DIVISION(209)468-3969 <br /> 2002 HAZARDOUS MATERIALS MANAGEMENT PLAN/INVENTORY <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. 0 <br /> h 1 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/FlIVR IP (EMMP97.171`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. (2� 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 Safety Code, Chapter 6.95, Article 1.61 <br /> Business Name a * AVT 02/6 d f;:�2– ,S"qlp OES Account#]8� <br /> Site Address ? N . U lt�Pt 43 17' Pe_*ff vl©� -44- ! r1' <br /> Facility Operator/Owner�AGfrJ��JC iS / C-1 17 Title C-d-4. <br /> el, <br /> _ (PRinn <br /> Signature `✓ Cn4/ "' Date lye 7 1 <br />