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16 .1F :._T. _ il�l,LLIrD I.AJA TE 209 466--',078 P.04 <br />Stitt of Capon _ F nvironatal, rgjeccion .Meaty . NO int or Toxic 3ubstanem Cunm)l <br />FACILTY NAME Northeast Community ParkiD Ni_AMBER CAH111000490 <br />?E�IpORARY HOUSEHOLD HA."LA"OUS WASTE, <br />COf�-ECAON FACILITY <br />PER -MIT BY RULE NOTIFICATION <br />IV OPER-\,1'OR CERTIFICATION (LBLIC AGENCY) <br />xtilf.' Ut)tief prtlslty d :W% that ?tus dwuument Arid ail after t®eaLS wCte [+r p,ucd :oder my Strei uon u, supcn suer :n a :ordDf � or s <br />TT em designed to assure that 44aitficd pesonnei properly �hcr aud evalawzthe utL' 11 T1 gubrrltti:xi 9ascd o^ mti mgwr the � gcan r: r <br />persons who ;:.anags Lhe S%19 tti ur those dvealy responsible for gash=g the :nfonnsiton, the - form811tm a to tt a cert o: my kflowlcugc and'oclieL <br />•r:_, wourve acid complete : am a%r'sre u:at there ue stipuficam pena tics for submitting!%U -afon a jorL ,rt:ludl^.g he posmbil,ty of tines a.^,d <br />�[.{7t•J.m¢ie�'nT for "uwmg c,eiauuns." <br />Director of Public <br />Henry M. _Hizata Warks <br />_. - -- <br />CJpcnttor Name(Fnm or Type! <br />- - ---y _ — Title - <br />S�gaati:re �� Datz Signed <br />DTSC 8464 (9/92) Page 4 of 4 <br />