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0 0 <br /> COUNTY OF SAN JOAQUIN RECEIVED <br /> _711F0 OFFICEROOMFEM RGENCo SERVICES DEC 23 <br /> 222 EAST WEBER AVENUE SMJOAQMOQW <br /> STOCKTON,CA 95202 1FM0F <br /> TELEPHONE(209)468-3962 <br /> _, A) HAZARDOUS MATERIALS DIVISION(209)468-3969 <br /> 2003 HAZARDOUS MATERIALS MANAGEMENT PLAN AND INVENTORY <br /> CERTIFICATION STATEMENT <br /> (See Reverse Side for Instructions) <br /> I. Business Identification Page, Hazardous Materials Management Plan, Facility <br /> Map(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 /> ` d <br /> ° I certify that the information contained in the most recently submitted <br /> C�Nr-� chemical inventory is complete, accurate, up-to-date, and contains the <br /> r� o information required by Section 11022 of Title 42 of the United States L 11ty` 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 /> ❑ 1 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 T��X j���,L,r/r/„i�.f� OES Account# <br /> Site Address V$'-Oo 441)1. �9�Z.otifa� it'd• <br /> Operator/Owner �i���x �hi >G L/a�f Titles �,faL �, �r✓s . <br /> Signature _ _ Date ./2- -/8 —02� <br />