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02/19/97 WED 14:54 FAX 209 468 0914 SJDA 4 FLOOR WIUU5 <br /> low .r <br /> � Y <br /> COUNTY OF SAN JOAQUIN <br /> OFFICE OF EMERGENCY SERVICES Ror ALa l9ALDwIN <br /> CWR INAR7R <br /> ROOM 610,COURTHOUSE <br /> 222 EAST WEBER AVENUE r <br /> STOCKTON,CALIFORNIA 95202 5 ^ <br /> ..1'r TELEMONE(209)468-3962 <br /> HAZARDOUS MATERIALS DIVISION(209)a68-3969 .SIN ( 210 2. <br /> SAN JOB UIN <br /> 1996 HAZARDOUS MATERIALS MANN FORMN <br /> 1 �HW&ZMTerials Manneement Plan(Check one box vl <br /> to the <br /> azardous <br /> A. kd <br /> 1 certifytha <br /> aanr( havebeen <br /> since lechanges <br /> last HMMP or;HMMP update Materialswas <br /> submitted. <br /> B. ❑ I certify that there has Leen a change to the HMMP and updated sections are <br /> attached to the Certification Form in accordance with the Instructlons. <br /> 2. Cben cal Inve mry(Check Box A ar appropriate hax(es)in Bl <br /> A. W I certify that the last chemical inventory submitted to the Office of Emergency <br /> Services hau-ol changed. <br /> B, I certify that there haLb= a significant change since the last chemical <br /> inventory was submitted and that: <br /> p (1) I have listed chemicals deleted from our inventory on the 1996 <br /> Chemical Inventory Deletion Form <br /> ing <br /> ❑ (2) 1 have chemicalattached a 1996 Chemical s or significant quantity changes to the Certification Formnew <br /> _ <br /> I declare under the penalty of perjury that the above information is accurate to the best of my <br /> knowledge. I understand that false/inaccurate information may contribute to complications during <br /> a hazardous material incident and that I may be held liable for those actions- <br /> 1 <br /> Business Name <br /> EA <br /> Site Address t <br /> Facility Manager/Owner I Tidc_ O <br /> n+em <br /> .,, Date I!I/1 Z6 <br /> Signature_ <br />