Laserfiche WebLink
FACILITY NAME Park and Ride Parking Lot ID NUMBER <br />TEMPORARY HOUSEHOLD HAZARDOUS WASTE <br />COLLECTION FACILITY <br />PERMIT BY RULE NOTIFICATION <br />III. OPERATOR CERTIFICATION (PUBLIC AGENCY) <br />CAH 1 11000681 <br />"I certify under penalty of law that this document and all attachments were prepared under my direction or supervision ir. <br />accordance with a system designed to assure that qualified personnel properly gather and evaluate the information submitted. Based <br />on my inquiry of the person or 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. 1 am aware that there are significant penalties <br />for submitting false information, including the possibility of fines and imprisonment for knowing violations." <br />Steven Winkler <br />Operator Name (Print or Type) <br />Sig afore <br />n_—D p ro=am Director-,/operat=er <br />Title <br />-/A q /0D <br />Date Si e <br />DTSC 8464 (9/92) Page 4 of = <br />FS/ADM rNFORMS\PBR FORM <br />