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aQul. o COUNTY OF SAN JAUI <br />OFFICE OF EMERGENCY SERVICES RONALD E. BALDWIN <br />a <br />ROOM 6I0, COURTHOUSE DIRECTOR OF <br />J. 222 EAST WEBER AVENUE EMERGENCY OPERATIONS <br />STOCKTON, CALIFORNIA 95202 <br />TELEPHONE (209) 468-3962 <br />HAZARDOUS MATERIALS DIVISION (209) 468-3969 <br />2002 HAZARDOUS MATERIALS MANAGEMENT PLAN/INVENTORY <br />CERTIFICATION STATEMENT <br />(See Reverse Side for Instructions) <br />1. Business Identification Page. UNIMP, Unstaffed Facilitv Network Attachment, and Facilit <br />Map - Check one box only <br />A. I certify that there have been no changes to the above listed documents since <br />our business's last update or change was submitted. <br />B. ❑ I certify that there has been a change to one or more of the above documents <br />and that either 1) appropriate revised hard copy forms, or 2) a complete revised <br />electronic copy of our Business ID Page P (HMMP97.FP3 File) and, if <br />appropriate, our Unstaffed Attachments (STAFF97.FP3 File) has/have been <br />transmitted concurrently with this Certification Statement. <br />2. Chemical Inventory (Chemical Description Page) - Check one box only <br />A. Ur r I certify that the information contained in the most recently submitted chemical <br />w-44"- inventory is complete, accurate, up-to-date, and contains the information <br />required by Section 11022 of Title 42 of the United States Code. I further <br />certify that there has been no change in the quantity of any hazardous material <br />reported and that no hazardous materials are being handled that are not listed. <br />B . jje I certify that there has been a change in our chemical inventory since the last <br />chemical inventory was submitted and either 1) completed hard copies of <br />Chemical Description Pages with "Add", "Delete", or "Revised" marked <br />appropriately, or 2) a complete revised electronic copy of our chemical <br />inventory (CHEM97 File) has been transmitted with this Statement. <br />3. Environmental Contact E -Mail Address (if available) <br />I understand that false/inaccurate information may make my company liable in an emergency. I <br />further certify that I have reviewed the above listed documents and information contained in the <br />most recently submitted chemical inventory and have ensured that it meets the requirements of <br />California Health and Saf'et�y Code, Chapter 6.95, Article 1. <br />Business Name ` ( f,'. "Co o OES Account # <br />Site Address 6 rte T `®J CA �T <br />Facility Operator/Owner _ wry_ Title TD, <br />(PRINT) <br />Date 'd 1 L <br />