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EPA ID#: 1- <br /> Model: letter 8 - <br /> 9 - <br /> 10 - <br /> DATE: 29- <br /> 2 - <br /> 3 - <br /> 4 - <br /> 5 - <br /> 6 - <br /> TO WHOM IT MAY CONCERN: <br /> "I certify that I am not required to submit a closure financial assurance mechanism because my <br /> closure cost estimate is not more than$10,000.00. A copy of the certification form(DTSC Form <br /> 8113(1/96))and the detailed closure cost estimate are attached." <br /> "I certify under penalty of law that this document and all attachments were prepared under my <br /> direction or supervision in accordance with a system designed to assure that qualified personnel <br /> properly gather and evaluate the information submitted. Based on my inquiry of the person or persons <br /> who manage the system,or those directly responsible for gathering the information,the information is, <br /> to the best of my knowledge and belief, true, accurate and complete. I am aware that there are <br /> significant penalties for submitting false information,including the possibility of fines and imprisonment <br /> for knowing violations." (Section 66270.11) <br /> Name (Print or Type) Title <br /> Signature Date <br /> A-38 Financial Assurance&Financial Responsibility Appendix <br />