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FACILITY NAME North County Recycling Center <br />TEMPORARY HOUSEHOLD HAZARDOUS WASTE <br />COLLECTION FACILITY <br />PERMIT BY RULE NOTIFICATION <br />IV. OPERATOR CERTIFICATION (PUBLIC AGENCY) <br />ID NUMBER CAH 1 1 1 000526 <br />"I certify under penalty of law that this document and all attachments were prepared under my direction or <br />supervision in accordance with a system designed to assure that qualified personnel properly gather and evaluate the <br />information submitted. Based on my inquiry of the person or persons who manage the system, or those directly <br />responsible for gathering the information, the information is, to the best of my knowledge and belief, true, accurate <br />and complete. I am aware that there are significant penalties for submitting false information, including the <br />possibility of fines and imprisonment for knowing violations." <br />ALISON HUDSON <br />Operator Name (Print o Type) <br />Signa re <br />MANAGEMENT ANA-LYST !I! <br />"Title <br />Date Signed <br />Z -lo- Oy <br />DTSC 8464 (10/97) Page 0 of 4 <br />FSAADMINFORMSTBR FORM <br />