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TECHNICAL CERTIFICATION STATEMENT FOR THE PERFORMANCE REPORT (optional Format) I certify this Hazardous Waste Management Performance Report identifies factors that affect the generation and on-site and offsite management of hazardous wastes and summarizes the effect of those factors on the generation and on-site and off-site management of hazardous wastes. Name Signature Title Mo/ Day/Year The intent of the financial certification for the Performance Report is to ensure that the person who is capable of committing the financial resources necessary to implement the Performance Report" is aware of its contents and the necessary resource commitment. The financial certification of the Performance Report must be completed by any one of the fol- lowing people who is capable of committing financial resources necessary to implement the source reduction measures: • The owner; • The operator; • The responsible corporate officer; or • An authorized individual. The person completing the financial certification in the Report must sign and date the fol- lowing language that is required by SB 14: V "I certify that this document and all attachments were prepared under my direction or supervi- sion in accordance with a system designed to assure that qualified personnel properly gather and y evaluate the information submitted. Based on my inquiry of the person or persons who manage the i p system,or the persons directly responsible for gathering the information,the information p0. submitted is,to the best of my knowledge and belief,true,accurate and complete. I am aware that V there are significant penalties for making false statements or representations to the Department, y including the possibility of fines for criminal violations." C.. i G� �-' Name Signature s / / V Title Mo/ Day/Year 54