Laserfiche WebLink
THU 00:SO �SORO TEL NO:209-4X66 #629 P07 <br /> LPA W <br /> L LXBj1�pjON'OM FINANCIAL ASSURANCEQ <br /> This section is for apo NTS: <br /> Condittona!Autho • ttaer or opargtpr of TrU Owner <br /> Title 22, CCRetron who is moble or i ib a fo an exemptionor ofU' or a generator operas <br /> seCtiOp tS7450.13(c). If you anC pot ce fm operating Ptusu., to a r <br /> assurance, Please see inshttctloA for this sx[ian. m fmanei.1 ass grant of <br /> Crain as [o whether you qualify for anu mpr pp from t-i Pursuant to <br /> C[1 <br /> -rifm•rltla <br /> i1�e alsa26 256 ifiEffl)CII011 LOL[Ql2 4MNbu� 1 <br /> assurance, please see instruction for Ibis smhon <br /> . <br /> please check the appropriate box: <br /> I As 2'I"I"() owner or operator or'EIV owner or operator, I have not operated more than thirty days in a <br /> calendar year. <br /> Note: IP box (1) is marked, Yom treatmenton are not eligible for this exemption. <br /> unit(s) must be operating under)."BR to be eligible for the 30 day <br /> exemption. Generators operating under Conditional Authariexemption. <br /> mtl <br /> Be sure to sign the owner or operator certification below. <br /> 2. 1 am required to provide a mechanism and it is attached to this form. <br /> Note: If box (2) is marked, you must complete all sei:tions of this form (Nyb%.; 1L` <pi6»• <br /> the owmOr or operator Certification below. <br /> f ant not required to provide a mechanism. Specify why'— <br /> Note: Ir box (3) is marked+ please sign the owner or operator certification below and attach your self- <br /> certification letter to this Corm. <br /> '. OWNER OR OPERATOR CERTIFICATION: <br /> my <br /> "I certify under penalty of law that this document and all atta erIe ns were prepared under <br /> evaluate the ion or supe ninon <br /> in accordance with a system designed to assure that qualified p t p Y € <br /> submitted. Based on my inquiry of the person or persons who manage the system, f, those directly responsible for <br /> gathering the information, the information is, to the bcst of my inforcdgc and belief, tate, accurate and complete. I <br /> ant aware that them are significant penalties for submitting Exist information, including the possibility of fines and <br /> imprisonment for knowing violations." <br /> 1 <br /> NAME (PR1NT OR TYPE) TITLE <br /> SIGMA"FC7RE DATE SIGNED <br /> PAGE 3 OF 3 <br /> d�SC 1232(8/96) For�rrir 8113(1196) <br />