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EPA ID NUMBER C A z3 S-7 <br /> TRANSPORTABLE TREATMENT UNIT PERMIT-BY-RULE <br /> SITE-SPECIFIC NOTIFICATION <br /> X. CERTIFICATIONS: Thu form must be signed by an authorized corporate officer or any other person in the company who <br /> has operational control and performs decision-making functions that govern operation of the facility(per CCR,title 12, <br /> (CCR)section 66270.11). Both copies must have original signatures. <br /> OWNER Certification I certify that the unit or units described in these documents meet the eligibility and operating <br /> requirements of state statutes and regulations for the indicated permitting tier,including generator and secondary containment <br /> requirements. <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. <br /> I am aware that there are substantial penalties for submitting false information,including the possibility of fines and <br /> imprisonment for knowing violations. <br /> pt s � W- AAr ,a . 4"^ '4 <br /> Name(Print or Type) Title <br /> Oa W, /,w L, W(,lC <br /> Signature DateSid <br /> OPERATOR Certification I certify that the unit or units described in these documents meet the eligibility and operating <br /> requirements of state statutes and regulations for the indicated permitting tier,including generator and secondary containment <br /> requirements. <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. <br /> I am aware that there are substantial penalties for submitting false information,including the possibility of fines and <br /> imprisonment <br /> lfor knowing violations. <br /> Name(Print o�r�Type) Title f� <br /> tt4l' fol <br /> Signature Date Signed <br /> SUBMISSION PROCEDURES <br /> You must submit two sets of this completed notification,with original signatures and attachments,by certified mail,return <br /> receipt requested,to: <br /> Department of Toxic Substances Control <br /> Program Data Management Section-HQ 10 <br /> Attn: TTU Notifications <br /> 400 P Street,4th Floot�Room 1493 (walli in only) <br /> P.O.Box 806 <br /> Sacramento,CA 93812-0806 <br />