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a 0 <br />COUNTY OF SAN JOAQUIN <br />OFFICE OF EMERGENCY SERVICES <br />ROOM 610, COURTHOUSE <br />222 EAST WEBER AVENUE <br />STOCKTON, CA 95202 <br />TELEPHONE (209) 468-3962 <br />HAZARDOUS MATERIALS DIVISION (209)468-3969 <br />DEC -9 2w <br />fiY Jn7 mcOri48dbtlhiU tia3.'1 I A� <br />('��EtS�u�.i'fi'1 �zr119BCE <br />2003 HAZARDOUS MATERIALS MANAGEMENT PLAN AND INVENTORY <br />CERTIFICATION STATEMENT <br />(See Reverse Side for Instructions) <br />Business Identification Page Hazardous Materials Management Plan Facile <br />Ma/n(s) Certification - Check one box only <br />ISI 1 certify that there have been no changes to the above listed documents <br />since our business's 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 />Q� 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 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 <br />Vt\' yA/E-/ %'/"Afel- P'CO'4y LOES Account # <br />7(0 76� <br />Site Address Pa S, i-. g w `r 9 F. ,�,4 q4'. <br />Operator/Own er/oV9✓�°" �^�6F✓ Title <br />Signature Date <br />I Z 4;—/t— <br />