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oPO UtN O <br /> COUNTY OF SAN JOAQUIN <br /> .y OFFICE OF EMERGENCY SERVICES RONALD E. BAL.DWIN <br /> N: < Eoowouwiow <br /> Rooth 610,CovwrwoosE <br /> 222 EAST WEBER AVENUE <br /> STOCKTON. CALIFORNIA 95202 <br /> 9l1 F O R TELEPHOHE12091 4683962 <br /> HAZAwoOps Ma[auLS DIVISroN 12091-683969 <br /> 1995 HAZARDOUS MATERIALS MANAGEMENT PLAN/INVENTORY <br /> CERTIFICATION FORM <br /> 1 . Hazardous Materials Management Plan <br /> A. ❑ 1 certify that there have been no changes to the Hazardous Materials <br /> Management Plan (HMMP) since the last HMMP or HMMP update was <br /> submitted. <br /> B. lH I certify that there has been a change to the HMMP and updated sections are <br /> attached to the Certification Form in accordance with the instructions. <br /> 2. Chemical Inventory <br /> A ❑ I certify that the last chemical inventory submitted to the Office of <br /> Emergency Services has not changed. <br /> B. I certify that there has been a significant change since the last chemical <br /> —/ inventory was submitted and that: <br /> lr ( 1 ) I have listed chemicals deleted from our inventory on the back of the <br /> / Certification Form. <br /> O ( 2 ) 1 have attached a 1995 Chemical Inventory Form(s) showing new <br /> chemicals or significant quantity changes to the Certification Form. <br /> I declare under the penalty of perjury that the above information is accurate to the <br /> best of my knowledge. I understand that false/inaccurate information may contribute to <br /> complications during a hazardous material incident and that I may be held liable for <br /> those actions. <br /> Business Name N (EE�Id Az Si (LA � 25�? �n C -L� <br /> St ;� Ccti F� <br /> Site Address �J�7L� � �� C N�` '2Ct\ � S �� <br /> Facility Manager/Owner MSK X . V t hJ Title <br /> (PRIM)Signature x (/�—n ted' 1 ` Date <br /> Name of Person FFI_-Et' <br /> C— IS, JCL TitIeTECi\ ` (2� <br /> RESPONSIBLE FOR THE COMPLETION OF THE INT) <br /> Signature <br />