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Uz lanaI nnu 14:54 PAA 2U9 4U4 0314 SJDA 4 FLOOR teiUUU <br /> - COUNTY OF SAN JOAQUIN <br /> _ OFFICE OF EMERGENCY SERVICES {r U LS i AoaAL$E.i•u OW IN <br /> �. �� ApOM 61Q CGURT..Y9E I I,1[ _,'1 <br /> 222 EAST WEWA AVENUE ! ! <br /> STOCKTON. CALIFORNIA 95202 I'� JAN — 6 t iJ <br /> •iisoa`' nu:.�onE12VY1sesaysx <br /> M�I=. S M.YTE..I IN MON I2 W)4§W3"iI S <br /> SQIY JUe4U:f.'3UIJTY <br /> nrlf��f EM•ERU.NCY;ERVICES <br /> 1995 HAZARDOUS MATERIALS MANAGEMENT PLAN/INVENTORY <br /> CERTIFICATION FORM <br /> 1. <br /> Hazardous Materials Management Plan <br /> A yJ I certify that there have been ns changes to the Hazardous Materials <br /> Management Plan (HMMP) since the last HMMP or HMMP update was <br /> submitted. <br /> g, ❑ I certify that there has been a change to the HMMP lnd updated sections are <br /> attached to the Certification Form in accordance with the instructions. <br /> 2. Qhamica/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 gnd that: <br /> ❑ ( 7 ) I have listed chemicals deleted from our inventory on the back of the <br /> Certification Form. <br /> ❑ ( 2 ) 1 have attached a 1995 Chemical Inventory Form(s) showing new <br /> chemicals or significant quantity changes to the Certification Form. <br /> 1 declare under the penalty of perjury that the above information is accurate to the <br /> best of my knowledge. 1 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 /> r411111 <br /> � <br /> Business Name <br /> qC <br /> Site Address I s M <br /> Title <br /> Facility Manager/Owner MI <br /> Date <br /> Signature <br /> iru p/ Title <br /> Name of Person (FPoM) <br /> I,EB.oNW8LEF0PnE0QWkETI0N0.�E"iW <br /> Date <br /> Signature <br />