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ti <br /> FACILITY NAME North County Recycling Center ID NUMBER CAH111000526 <br /> TEMPORARY HOUSEHOLD HAZARDOUS WASTE <br /> COLLECTION FACILITY <br /> PERMIT BY RULE NOTIFICATION <br /> IV. OPERATOR CERTIFICATION(PUBLIC AGENCY) <br /> "I certify under,penalty of law that this document and all attachments were prepared under my direction or <br /> supervision in accordance with a system designed to assure that qualified personnel properly gather and evaluate the <br /> information submitted. Based on my inquiry of the person or persons who manage the system, or those directly <br /> responsible for gathering the information, the information is, to the best of my knowledge and belief, true, accurate <br /> and complete. I am aware that there are significant penalties for submitting false information, including the <br /> possibility of fines and imprisonment for knowing violations." <br /> ALISON HUDSON MANAGEMENT ANALYST III <br /> Operator Name(Print or Typ Title <br /> 4—�— <br /> Signature bate Signed <br /> DTSC 8464(10/97) Page ❑ of 4 <br /> F&ADMINFORMSTBR FORM <br />