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FROM : FAX NO. : 22 2001 08:40PM P1 <br />2-13-28702 3;02vtn WkN .,OAQUIN CO. OES 209 944 goO 0.2 <br />*104, <br />COUNTY OF SAN JOA UIN <br />OFFICE OF EMERGENCY SRVICES XOsALna. aALOWIN <br />RooM 619, coupmio 15E D1kectvv of <br />222 BAST AMBER AVENUE STOCKTON, CALff-ORNIA 95202 <br />TELEPHONE (109,46g,3962 <br />HAZARDOUS MATIWALS OIVIStON tZov1 46t.3%9 <br />2002 HAZARDOUS MATERIALS MANAGEMENT PLANIINVENTORY <br />CERTIFICATION STATEMENT <br />(See Reverse Side for Instructions) <br />Bumess Identification Pgge HNW Unstaffed t ili(y Network h c ,tt, <br />eand Facii' v <br />ox <br />Map <br />A. 1 certify that there have been RQ charges to the above listed documents since <br />our business's last update or change was submitted. <br />B. O I certify that there hall= a change to Wine or mote of the above documents <br />and that either 1) appropriate reviser' hard copy forms, a• 2) a complete revised <br />electronic copy of out Business ID Pa9c4flVIMP (H?01P97.FP3 File) and, if <br />appropriate, our Unstaffed .Auachmants (STAFF97.FP3 File) hasihave been <br />tr>Irismitted concurfentl, with this Certification Statement. <br />chemical lnvenjty�(Chemi,;d! D "tion Pa t <br />A. 1 :ert.ify that the information contained in the most recently Submitted chernical <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 them 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 - d I certify that there has been a change m our chemical inventory since the last <br />chemical inventory was subfnitted and Eftba 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 (CIIEM97 File) has been transmitted with this Statement. <br />Environmental Contact E -Mail Address (if avail ) I <br />I understand that falscanaecarate information may mahe m7 cempany liable in an emergency. I <br />further certify that I have reviewed the above 116ied document0 and information contained in the <br />most recently submitted chemical inventory and have ensured th.t IT meets the requirements of <br />California Health//and Safety Code, nChapter 6.95, Article 1. <br />BusinessNarnn7iy�/.,7 /A" -e / 707 OSS Aceoun_(9 <br />Site iddr&;% Adcp-f;�d <br />7 <br />Facility Operator/OwnerV� <br />Title- <br />�m <br />Sign Date S-13 <br />