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COMPANY NAME: ���r�^ ^�� "✓ ID No.: CJ r 031 JJol <br /> (See instructions on reverse) <br /> V. ATTACHMENTS <br /> I <br /> A. A plot plan detailing where the hazardous waste treatment(s) will occur. <br /> B. A certification specifying the local agencies that have been notified of the operation. <br /> C. ] A copy of any local air district permit or other permits required for the operation of the TTU. <br /> D. ] Documentation that the property owner has been notified of the Operation of the TTU, if <br /> the property owner is different from the facility operator. <br /> E. ] The certification(s) for generators specified in Title 22, CCR, Section 66262.45, if applicable. <br /> F. The corrective action certifications required by Title 22, CCR, Section 67450.7, if applicable. <br /> G. The containment system certification required by Title 22, CCR, Section 66264.175(c). <br /> VI. OWNER CERTIFICATION <br /> "I certify under penalty of law That this document and all attachments were prepared under my <br /> direction or supervision in accordance with a system designed to assure that qualified personnel <br /> properly gather and evaluate the information submitted. Based on my inquiry of the person or <br /> persons who manage the system, or those directly responsible for gathering the information, the <br /> information is, to the best of my knowledge and belief, true, accurate, and complete. I am aware <br /> that there are significant penalties for submitting false information, including the possibility of fines <br /> and Imprisonment for knowing violations." <br /> YYIAP A&eP- El`iVl Ep 11 d fErkt F rG4t. <br /> 42o F2 I4 , " `UP�E12 bU PPrI uJL�I�pI�s(piunaJ A°tfi' <br /> ams on or fype <br /> VII. OPERATOR CERTIFICATION <br /> "I certify under penalty of law that this document and all attachments were prepared under my <br /> direction or supervision in accordance with a system designed to assure that qualified personnel <br /> properly gather and evaluate the information submitted. Based on my inquiry of the person or <br /> persons who manage the system, or those directly responsible for gathering the information, the <br /> information is, to the best of my knowledge and belief, true. accurate, and complete. I am aware <br /> that there are significant penalties for submitting false information, including the possibility of fines <br /> and imprisonment for knowing violations." �1 <br /> —i�A?-i2y <br /> Nan.( nnt� OrT� � i 19 <br /> ' narun San nW <br /> 4 <br /> DlstHbuf/on: DISC—while and Yellow; NOH er—Pink and lnshucHons <br /> QAC 41+A(11191) Page 5 of 5 <br />