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Dec 16 06 02: 53p San Joaquin OES 209-468 0273 p. 2 <br /> COUNTY m SAN JOAQUry RECEIVED <br /> OFFICE OF EMERGENCY SERV <br /> 10ES <br /> ROOMI 610,COURT14C)UsE DEC 2n, 2M6 <br /> 222 RAST WC8FR A vENUE <br /> STIDCKTON,CA 95202 SAN JUAQUIN COUNTY <br /> TL t,EYFtpN (2t)9 465.3yG? OFFICE OF EMERGENCY SERVICES <br /> HAZARDOUS MATERIALS 1jiVI.SloN(j(i9).j63-_v69 <br /> 2047 HAZARDOUS,MATERIALS-MANAGEMENT PLAN AND INVENTORY <br /> CERTIFICATION STATEMENT <br /> (See Reverse Side for Instructions) <br /> L3usiress Tele if: tion Pa..- 1 dour Material, li J <br /> !� s en ficatton -C4ec. obe bvx aniv ' enient Pla�adty <br /> l c0rtifY that there have been no changes to thy,above listed docurrents <br /> since our business`s IM update or chan&.e was suurnitted. <br /> ❑ I cetTifj that there. has b a change to one or mote of tlae above <br /> documents and that appropriate r'rvised hard cop? forms have been <br /> submitted with this Certification Statement. <br /> 2. 'crt' icatiou 0f Chemical Inventory - Ch one box only <br /> I certify,that the inliirmatiott contained in the most recently submitted <br /> chetnival invetxtorI is complete, accurate, up-to-date, and contains the <br /> infortndtiou required by Section 11 p.�2 of Title 42 of rhe Unit:.-d States <br /> Codc. I further certify that there has been no change in tha quantity of anv <br /> ha=dous materiai reported and that no hazardous materials are being <br /> handled in regulated quantities that are not listed. <br /> ❑ I ccrtify that there h - been a change;in my chemical inventory since the <br /> Int submission and completed had 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 Bible in an <br /> emcrgency. I further certify that I have reviewed the above listed documents and that <br /> the Statements checked abor'c constitute an accurate statement. <br /> Busine&i Name �(G � L t �OES Account# <br /> Site t#ddre5s (�Z�i—Is�_�1 LrOY- <br /> Operator!Oumer lYl e e(t Title <br /> Signature Date _ , 66 — <br />