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FP.OM : 01AXNO. : Maw 68:45Ph1 <br />FE.-CEIVE►D <br />COUNTY OF SAN JOAQUIN FEB 13 2003 <br />OFFICE OF EMERGENCY SERVICES <br />4 <br />ROOM 610, COURTHOUSE SAN JGAQUIN COUNTY <br />222 FAST WEBER AVENUE eFIGE OF EMERGENCY SERVICE' <br />STOCK rON, CA 95202 <br />ti! fELCMIONE(209) 4DR-3962 <br />• �� . ;�- HAZARI)OUSMATERIALSDIVISION(209)46%-3769 <br />Y. <br />2003 HAZARDOUS MATERIALS MANAGEMENT PLAN AND INVENTORY <br />CERTIFICATION STATEMENT <br />(See Reverse Side for Instructions) <br />Business Identification Pae I I:vardous Materials Management Plan. Facility <br />M p(sl�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 />❑ 1 certify that there has been a change to one or more of the above <br />documents and that appropriate revised hard copy fortes have been <br />submitted with this Certification Statement. <br />2. Certification of Chemical Inventory - Check one box only <br />AI certify that the inlixmation contained in the most recently submitted <br />c chemical inventory is complete, accurate, up-to-date, and contains the <br />�1 M' 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 />❑ 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.�p��j�,,6��' OFS Account # ` �'cl <br />Site Address /p15 W, / ,�d 31, ai <br />Operator/Owner Title <br />Signature Date <br />