HomeMy WebLinkAboutHAZARDOUS MATERIALS 3-26-2009Unidocs - Uniform Documents
Mazard~u~ .~llateri~ls C°?n1~r~~ In~r~nt~ry ~Pr~je~~
Business Certification Form
Page 1 of 2
All fields highlighted in red indictate that the field has not been electronically submitted yet.
I. AGEIdC~l IDENTIFICATIOId - -~
AGENCY NAME:
MAILING ADDRESS: CITY: ZIP:
~~
II. FACILITY IDENTIFICATION
Pursuant to Section 2b503.3(c) of California Health and Safety Code (H8~SC), the Hazardous Materials Business Plan (HMBP) ceRiflcation
described below is hereby submitted for the following facility:
FACILITY NAME: FACILITY ID#:
FLOYD'S STORES, INC. 15-021-TMP289
STREET #: STREET NAME: CITY: ZIP:
~~ 3650 CHESTER AVENUE BAKERSFIELD 93301 ~
DATE OF CURRENT HMBP:
, ..o
~
................. ... ........ ......,....,.........,..,.._,..... _ .....,.:
III. CERTIFICATION
I certif/y that: (Check the appropriate box.)
~ I have personally reviewed the Hazardous Materials Business Plan currently on file with your agency and certiTy that the HMBP is complete aro
accurate. (See bottom of page for details.)
~ Revisions to the Hazardous Materials Business Plan are necessary. The HMBP as revised is being implemented. A copy of the revisions is
enclosed with this Certification.
OWNER/OPERATOR CERTIFICATION: 1 hereby certify under penalty of law that, based upon my inquiry of those fndividuals responsible fo
obtaining the information reported above, I believe that the submitted Information is true, accurate, and complete. I understand that a revis
HMBP must be submitted within 30 days of any change in this facility's storage or handling of hazardous materials which would require
updating of the HMBP.
SIGNATURE OF OWNER/ RATOR:
_Select.."....~._~ :~i ~~
~--
NAME OF OWNER/OPE OR:
_....._....__...._..__.... _....._..._ ................_........._._..__..__................................_............._....
~._~~,a-t......_~..._~ ..............................._ ..... ...._ . __ _. .__.
By checking the upper box on this form, you are certifying that:
DATE SIGNED:
3 y o ~°
' ~ 6~ q ~~
, ...........................i
TITLE OF OWNER/OPERATOR:
... _ ..... .. .................................._......~..._...............__ _ .
~~-' ~ ~ . . . . ........ .. . . . . _ . _ _.... _. . . _.. _.. . .
• The information contained in the HMBP most recently submitted is complete, accurate, and up-to-date; and
• There has been no change in the quantity of any hazardous material as reported in the most recentiy submitted Hazardous Materials Inventory form
and
• The facility has not begun handling any hazardous material in a HMBP reportable quantity which is not currently listed in the Hazardous Materials
Inventory; and
• The HMBP most recently submitted HMBP contains the information required by Section 11022 of Title 42 of the United States Code; and
• There have been no substantial changes in the facility's hazardous materials operations which would require revision of the current HMBP.
Update Business Plan Certification form
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