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07-02-1998 05:07PM FROM MSE Environmental, Inc. TO 912094b830718 P.07 <br />FACILITY NAME Park and Ride Parkin Lot ID NUMBER CAH111000681 <br />TEMPORARY HOUSEHOLD HAZARDOUS WASTE <br />COLLECTION FACILITY <br />PERMIT BY RULE NOTIFICATION <br />III. OPERATOR CERTIFICATION (PUBLIC AGENCY) <br />1 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 submitted. <br />Based on my inquiry of the person or persons who manage the system, or those directly responsible for gathering the <br />information, the information is. to the best of my knowledge and belief, true, accurate and complete. I am aware that there <br />are significant penalties for submitting false information, including the possibility of fines and imprisonment for knowing <br />violations." <br />Steven Winkler <br />Operator Name (Print or Type) <br />Signature <br />DTSC 8464 (9/92) <br />FS/ADMNFORMSTBIR FORM <br />Title <br />Date Signed <br />Deputy Director/Operations <br />Page 4 of 4 <br />