Laserfiche WebLink
ACILITY NAME Salas Park Parking Lot I P NUMBER AH 111000318 <br />TEMPORARY HOUSEHOLD HAZARDOUS WASTE <br />COLLECTION FACILITY <br />PERMIT BY RULE NOTIFICATION <br />III. OPERATOR CERTIFICATION (PUBLIC AGENCY) <br />"I 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 />DTSC 8464 (9/92) Page o f 4 <br />FS/ADMINFORMSTBR FORM <br />.............I._____.._ _..._..........................._._._ _._ ...... .........._��__ _ ____------___� _____.__.._...._... ..... __..._..__..._.__........................ ..._...__.__...__. <br />Operator Name (Print or TypeTitle <br />ALISON HUDSON MANAGEMENT ANALYST III <br />._.........._.... ._ <br />igna ate Signed <br />DTSC 8464 (9/92) Page o f 4 <br />FS/ADMINFORMSTBR FORM <br />