Laserfiche WebLink
DTSC HEADQUARTERS Fax:916-327-4495 Apr 10 '06 8:52 P.06 <br /> Mp_ <br /> State of California-California Enviro mtection Agency Wepartment of Toxic Substances Contro) <br /> laws, worker health and safety laws, local zoning requirements and Seismic and precipitation design standard <br /> requirements. <br /> t. Certification <br /> I certify under penalty of law that this document and all attachments were prepared under my direction or supervision in <br /> accordance with a system designed to assure that qualified personnel properly gather and evaluate the information <br /> submitted. Based on my inquiry of the person or persons who manage the system,or those persons directly responsible <br /> for gathering the information,the information submitted is,to be 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 possibility of <br /> fine and imprisonment for knowing violations. (title 22, California Code of Regulations, division 4.5,chapter 20,seotion <br /> 66270.11(d)] <br /> 0-;.3-04 <br /> 0rlgiin4al &i9c&n&atu_re(non-black ink) Title Date <br /> J. Notifications must be submitted to DTSC by certified mail, return receipt request. <br /> MAIL TO: Department of Toxic Substances Control <br /> Hazardous Waste Management Program <br /> Regulatory Program Development Division <br /> P.O.Box 806 <br /> Sacramento, CA 95812-0806 <br /> .Attention: UWED/CRT Materials Handling Activities <br /> DTSC XXXX(10104) Page sots <br />