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SAN JOAQUIN COUNTY OFFICE OF EMERGENCY SERVICES <br /> HAZARDOUS MATERIALS PROGRAM RFCEIVED <br /> FEB 18 1999 <br /> ENVIHOt,4MEWAL HEALTH <br /> PERMIT/ SERVICES <br /> DECLARATION OF COMPLETENESS AND ACCURACY <br /> I certify under penalty of law that I have personally reviewed the Hazardous Materials Management Plan <br /> andjnventory submitted by my business and have ensured its completeness and accuracy to the best <br /> of my knowledge. I understand that false/inaccurate information may contribute to avoidable <br /> complications during a hazardous materials incident. <br /> Name of Business <br /> Name of Facility Ope for/Owner <br /> �Q✓�h e� <br /> Title of Facility Operator/Owner <br /> ignature (in ink) <br /> /Z,? <br /> Date <br /> SJC 12/97 <br />