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u- a 4 RECEIVED <br />COUNTY OF SAN JOAQUIN U t L 14 Yuu I <br />a 'A� OFFICE OF EMERGENCY SERVICES RONA6MJQA NWA A"j* <br />r. t <br />ROOM 610, COURTHOUSE 0FMV6FN(W%R", <br />222 EAST WEBER AVENUE EMERGENCY OPERATIONS <br />••.,• �� • STOCKTON, CALIFORNIA 95202 <br />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. I 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. a 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/lEgMP (HMMP97.FP3 File) and, if <br />appropriate, our Unstaffed Attachments (STAFF97.FP3 File) has/have been <br />transmitted concurrently with this Certification Statement. <br />Chemical Inventory (Chemical Description Pagel - Check one box only <br />A. O 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. Jid 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 />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. <br />Business Name &Dn 4rm dtr✓I,4A-- OES Account # LIY7 <br />Site <br />Facility <br />(MlK <br />Title QQQyG�-r'o itasse�i�r <br />Date <br />