Laserfiche WebLink
0 • RECEIVED <br />Statement of Exemption OCT - 4 2010 <br />]FFIC OF EM RBE CCYSERVICES <br />Statement Of Exemption only to be completed if you do NOT have to prepare a plan. <br />Business Name: <br />Business Address: <br />Business Telephone: <br />I understand the requirements for submitting a Hazardous Materials Business Emergency Plan and I declare, <br />tinder penalty for perjury, that a Hazardous Materials Business Emergency Plan is not required for this business. <br />Business Owner/Operator Name: <br />Date: <br />Signature: <br />Title of Signer: <br />Reason you believe your business is exempt: <br />Revised (5/03) <br />