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r COI E OF OF SAN JOAQUIN REFCEIVED <br /> OFF2101 E. EARRT STOCKTON,CAN 95206 APR 300 APR 12 Zoll <br /> TELEPHONE(209)953-6200 OFFICEANJ0A0U1NC0 <br /> •. .< FAX(209)953-6268 OFE UN <br /> MERGENCV SERVICES <br /> 2012 HAZARDOUS MATERIALS MANAGEMENT PLAN AND INVENTORY <br /> CERTIFICATION STATEMENT <br /> (See Reverse Side for Instructions) <br /> 1. Business Identification Page, Hazardous Materials Management Plan Facility <br /> May(s) Certification - Check one box only <br /> I certify that there have been no changes to the above listed documents <br /> since our business' 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 /> 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 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 in regulated quantities that are not listed. <br /> ❑ I 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 D G'1"1'L Sys-t Wm 1, OES Account # 14 11 5 <br /> Site Address (0909 TAM O St-V4V41)FR %v%'re 8 <br /> Operator/Owner S`t'ayaty p, WORStiS Title VIcE rm-w-wis, ctt'L- <br /> Signature ,0 7/g,.,� Date + - I% - 26Ol 2 <br />