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COUNTY OF SAN JOAQUIN <br /> h `� • OFFICE OF EMERGENCY SERVICES <br /> ttiE f — <br /> � ROOM 610,COURTHOUSE <br /> 222 EAST WEBER AVENUE <br /> >i STOCKTON,CA 95202 <br /> TELEPHONE(209)468-3962 <br /> -.� HAZARDOUS MATERIALS DIVISION(209)468-3969 <br /> 2004 HAZARDOUS MATERIALS MANAGEMENT PLAN AND INVENTORY <br /> CERTIFICATION STATEMENT <br /> (See Reverse Side for Instructions) <br /> 1. Business Identification Page, Hazardous Materials Management Plan, Facility <br /> May(s) Certification - Check one box only <br /> XI 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 /> 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 ah t� hall b Ya�� bYiI355 <br /> ES Acco # <br /> Site Address ��� �I 1 IU 1 �� ik—,Q 12(1_ <br /> Operator/Owner W+r I ��'�'�S��_ Title <br /> Signature Date 3 <br />