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04 <br /> +q - <br /> a� <br /> FINANCIAL C RTIFICATION: The compliance checklist must be reviewed and certified <br /> that the review r is made aware of the checklist contents and resource commitment. <br /> a Financial certif cation shall be made by any one of the following persons able to commit <br /> company finances. Check the appropriate box and provide the information below: <br /> Q the owner <br /> O the operator <br /> O the responsible corporate officer of the site <br /> ' an authorized individual capable of committing financial resources necessary to <br /> ' <br /> implement selected source reduction measures. <br /> "I certify 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 <br /> I properly gather and evaluate the information submitted. Based on my inquiry of the <br /> person or persons who manage the system, or the persons directly responsible for gathering <br /> the information, the information submitted is, to the best of my knowledge and belief, true, <br /> accurate and complete. I am aware that there are significant penalties for making false <br /> statements or representations to the Department, including the possibility of fines for <br /> criminal violatioris. <br /> Please print the name of the person certifying this compliance checklist: <br /> Name: i^ <br /> Title: ^( Y <br /> Signature: <br /> Date: / / <br />