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SEP-10-03 11 :49AM FROM-DTSC CYPR' T14-484-5392 T-851 P 03/08 F-258 <br /> +L..+vwa-aavaeomemat Ytorectim Aecnty Hops"==of lbxi sahsnacw:Canttol <br /> TI JRF-D MOVI 1 G PHASE I E.N MO?A E AL ASSLSS,)%MTN'T 091EACKUST <br /> SIGNATURE AND CERTIFICATION <br /> FOR <br /> lrFRAUT-By-RULE AND CONDITIONAL AUTHOBTLATION <br /> I <br /> ustrUetiorts: CaWUUy read the certification below. If you Peri uncgmfealable signing this <br /> rtification, review the insttvdiom and the information developed in the preparation of the dwddist <br /> nd corfeet any ddieie.saes yon have found. Be sure that you ebe&' one of the boxes below to record <br /> our decision regarding further investigation. If you areClaimingexempionfromcompletjltgaPhase <br /> D Wai.�oameatal Assenanent, eumplete that vetion below. <br /> Either the Owner, operator, or iadepeadatt professional engtaeer, geologist,or an environmental assessor <br /> who is registered m the Stara of California, dull certify to the following statemeut by signing on the.appropriate <br /> lines below: <br /> Yes, further investigation is nmdeA to determine the existence, nature, and or extent of contamination at <br /> the facility: or <br /> X No, farther investigation ib not necessary to determine the existence,nature, andjor c tent of matamioatioo <br /> at the facility. <br /> I am exempt from completiag the checklist and/or from TWWring folio work. <br /> ez tian below �"rp [Please state reason for <br /> �P end euPP1Y documentary evidence (sen instntcxions)]_ Explanation: <br /> "Under penalty of perjury,I=rtify that I have personally examined and am familiar with the information <br /> submitted in this ducumew and all attachments, and based on my inquiry of those individuals imuediatriy <br /> nesponsible for obtaining it, the inforro"nu is true, accurate, and contplate to the best of my <br /> informed, T certify to my best jknowledge. Thus: <br /> that the conclusion recurded above regarding further investigation or <br /> exemption from completion of the phase I Environmental Assessment is correct. <br /> Owrrs's Signature Name, Title, and Company Name Date <br /> or <br /> Olxrator's Signntore Name, Title, and COWp y Name <br /> (If Owner is not Date <br /> Or Ccrtifitatiou by an independent professional engineer, grologist, or envimnmentel assessor who is registered <br /> is the State G ae razor Sign <br /> an affz by r xgisteted professionel is optional for Permit-By-Ryle and Conditionaiiy <br /> Authnrizc-d Geawaton. Sign and affix stamp. <br /> Signature Name, Tide, <br /> Rtsgistration Number Date <br /> DTSC 115] 0/95) <br /> Please mdeato twat nwabor arP�6e+�_of <br />