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Dec 16 09 02: 45p San .1naquin C 2099539?68 p- 2 <br /> �.;,:... COUNTY OF SAN JOA UIN <br /> OFFICE OF EMERGENCY SERVICES ECE1W® <br /> 2101 E.EARHART AVENUE,SUITE 300 <br /> DEC 2 2 2009 <br /> 1'e; {! STOCKTON,CA 95206 <br /> TELEPHONE(209)953-6200 SAN JO <br /> ' FAX(209)953-6268 OFRICE OF E AOUIN COUNTI' <br /> MERGENCY SERVICES <br /> 2010 HAZARDOUS MATERIALS MANAGEMENT PLAN AND INVENTORY <br /> CERTIFICATION STATEMENT <br /> (See Reverse Side for Instructions) <br /> 1. Business Identification Page, Hazardous Materials Management Plan,Facility <br /> Mav(s) Certification - Check one box only <br /> I certify that there have been no changes to the above listed documents <br /> since our business' last update or change was submitted. <br /> ❑ I certify that there has been a change to one or more of the above <br /> documents and that appropriate revised hard copy forms have been <br /> submitted with this Certification Statement. <br /> 2. Certification of Chemical Inventory- Check one box only <br /> I certify that the information contained in the most recently submitted <br /> chemical inventory is complete, accurate, up-to-date, and contains the <br /> information required by Section 11022 of Title 42 of the United States <br /> Code. I further certify that there has been no change in the quantity of any <br /> hazardous material reported and that no hazardous materials are being <br /> handled in regulated quantities that are not listed. <br /> ❑ I certify that there has been a change in my chemical inventory since the <br /> last submission and completed hard copies of changed Chemical <br /> Description Pages with"Add", "Delete", or"Revised" marked <br /> appropriately have been submitted with this Certification Statement. <br /> I understand that false or inaccurate information may make my company liable in an <br /> emergency. I further certify that I have reviewed the above listed documents and that <br /> the statements checked above constitute constitute an accurate statement. <br /> Business Name 1 V G► ("F L L yr,; �e� OES Account#-7 e3 <br /> Site Address �0 21�1 F_ , V,"C-{Zj r ��� �� � `i5�v <br /> Operator/Owner ) Title 4_!���� <br /> Signature Date_ J Z J l 9 <br />