Laserfiche WebLink
02/02/2011 11:30 2099511572 WES DAV GATE SYSTEMS PAGE 0"1 <br /> Jan 12 11 10: 12a <br /> San quin Co OES 2039S36261 p•2 <br /> COUNTY OF SAN JOAQUIN <br /> O <br /> aaulr <br /> to "6,. FFICE OF EMERGENCY SERVICES FEB <br /> 4 }g 2101 E.EARHART AVENUE,SURE 300 2 2011 <br /> STOCKrON,CA 95206 <br /> " Tt'UTHO E(Zon9FAX 6B62n0 ?FF/C&CFFCAQUINCC <br /> �R�NCVgER�Ctfi <br /> j` <br /> 2011 HAZARDOUS MATERIALS <br /> MANAGEMENT <br /> PLAN AND INVENTORY <br /> CERTIFICATION ON SN <br /> (See Reverse Side for Instructions) <br /> 1. Business Identification Pa a IQ iazardous Materials Mans cment Plan Fagh <br /> M Certification- Check one box Only <br /> l� I certify that there have been no changes to the above listed documents <br /> since our business' last update or change was submitted. <br /> ❑ 1 certify that there has been a change to one or more of the above a <br /> documents and that appropriate revised hard copy forms have been <br /> submitted with this Certification Statement, <br /> 2. Certification of Clip mical inventory -Check one box onlv <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 11.022 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 materiel reported and that no hazardous materials are being <br /> handled in regulated quantities that are notlisted <br /> p 1 certify that there has been a change in my chemical inventory since dirt <br /> last submission and completed bard 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,, jQ�.S.y f OFS Account# <br /> Site Address �D__ qU;1�1 rn JJiJ�11d� OR- Sf�c 7_ <br /> Operator/Owner R _ Title <br /> Signature Dale_(- ly -jJ <br />