COMPLIANCE INFO_PRE 2019 - Laserfiche WebLink

Home Browse Search

EPA IDNUMBER CA�000"730'7'l TRANSPORTABLE TREATMENT UNIT PERMIT-BY-RULE SITE-SPECIFIC NOTIFICATION X. CERTIFICATIONS: This form must be signed by an authorized corporate officer or any other person in the company, who has operational control and performs decision-making functions that govern operation of the facility (per Title 22, California Code of Regulations (CCR) section 66270.11). Both copies must have original signatures. OWNER Certification I certify that the unit or units described in these documents meet the eligibility and operating requirements of state statutes and regulations for the indicated permitting tier, including generator and secondary containment requirements. I certify under penalty of law that this document and all attachments were prepared under my direction or supervision in accordance with a system designed to assure that qualified personnel properly gather and evaluate the information submitted. Based on my inquiry of the person or persons who manage the system, or those directly responsible for gathering the inform,idoc, the information is, to the best of my knowledge and belief, true, accurate, and complete. I am aware that there are substantial penalties for submitting false information, including the possibility of fines and imprisonment for knowing violations. /I l NOMAS WTLLTL!}M NER L E N /F)/ R E !A- nQna aeR Name (Print or Type) Title Signature Date Signed OPERATOR Certification I certify that the unit or units described in these documents meet the eligibility and operating requirements of state statutes and regulations for the indicated permitting tier, including generator and secondary containment requirements. I certify under penalty of law that this document and all attachments were prepared under my direction or supervision in accordance with a system designed to assure that qualified personnel properly gather and evaluate the information submitted. Based on my inquiry of the person or persons who manage the system, or those directly responsible for gathering the information, the information is, to the best of my knowledge and belief, true, accurate, and complete. I am aware that there are substantial penalties for submitting false information, including the possibility of fines and imprisonment for knowing violations. T901V145 WZ-LL-TAM 14EALEHY ARF-R- tj4NR6E-R. Name (Print or Type) Title Signature Date Signed SUBNUSSION PROCEDURES You must submit two sets of this completed notification, with original signatures and attachments, by certified mail, return receipt requested, to: Department of Toxic Substances Control Program Data Management Section-HQ 10 Attn: TTU Notifications 400 P Street, 4th Floor, Room 4453 (walk in only) P.O. Box 806 Sacramento, CA 95812-0806 DISC Form 1197(1/96) Page 9 (Pravioualy DISC 9429A)