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COUNTY OF SAN JOAQUIN <br /> OFFICE OF EMERGENCY SERVICES RONALD L BALDWIN <br /> ROOM 610.COURTHOUSE COORDINATOR <br /> 222 EAST WEBER AVENUE <br /> STOCKTON,CALIFORNIA 95202 <br /> TELEPHONE(209)469-3962 <br /> HAZARDOUS MATERIALS DIVISION(209)468-3969 <br /> 1996 HAZARDOUS MATERIALS MANAGEMENT PLANANVENTORY <br /> CERTIFICATION FORM <br /> 1. Hazardous Materials Mana2ement Plan (Check one box only) <br /> A. Q I certify that there have been no changes to the Hazardous Materials <br /> Management Plan (HM[M[P) since the last HMMP or HMMP update was <br /> submitted. <br /> B. Q2 I certify that there has been a change to the HN1MP And updated sections are <br /> attached to the Certification Form in accordance with the instructions. <br /> 2. Chemical Inventory (Check Box A or appropriate box(es) in B) <br /> A. U I certify that the last chemical inventory submitted to the Office of Emergency <br /> 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 /> (1) 1 have listed chemicals deleted from our inventory on the 1996 <br /> Chemical Inventory Deletion Form. <br /> Cl (2) 1 have attached a 1996 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 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 /> Business Name V OtL) FAcit-ily, 11115- <br /> Site Address I&S-00 1—OV155 L ci C Ca CA 9"-)- -3L <br /> Facility Manager/Owner t JASSF-z ACA6tAN Title DeALF—C_ <br /> 1PRINM <br /> Signature- Date <br />