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State of California-California.Environmental Protection Agency Department of Toxic Substances Control <br /> TIERED PERMITTING PILASE I ENVIRONMENTAL ASSESSMENT CHECKLIST <br /> SIGNATURE AND CERTIFICATION <br /> FOR <br /> PERMIT-BY-RULE AND CONDITIONAL AUTHORIZATION <br /> Instructions:Carefully read the certification below. If you feel uncomfortable signing this certification,review <br /> the instructions and the information developed in the preparation of the checklist and correct any deficiencies <br /> you have found. Be sure that you check one of the boxes below to record your decision regarding further <br /> investigation. If you are claiming exemption from completing a Phase I Environmental Assessment,complete <br /> that section below. <br /> .................... .............. ................ ...................- ............ .. .......... <br /> Either the owner,operator,or independent professional engineer,geologist,or an environmental assessor <br /> who is registered in the State of California.shall certify to the following statement by signing on the appropriate lines <br /> below: <br /> Yes,further investigation is needed to determine the existence,nature,andlor extent of contamination at the <br /> facility;or <br /> X No,further investigation is not necessary to determine the existence,nature,and/or extent of contamination <br /> at the facility. <br /> I am exempt from completing the check-list and/or from resulting foflo-ivup work. [Please state reason for <br /> exemption below and supply documentary evidence(see instructions)]. Explanation: <br /> "Under penalty of perjury,I certify that I have personally examined and am familiar with the information <br /> submitted in this document and all attachments.and based on my inquiry of those individuals immediately <br /> responsible for obtaining it,the information is true,accurate,and complete to the best of my knowledge. Thus <br /> informed,I certify to my best judgement that the conclusion recorded above regarding further investigation or <br /> exemption from completion of the Phase I Environmental Assessment is correct." <br /> Michael L�aptalo, Metal Finishing Solutions, Inc. 9/18/2020 <br /> V <br /> ,.Titl,�, C an, <br /> Ovvner"s Signatu e �NamMeTitle,and Company Name Date <br /> Or: <br /> Operator's Signature Name.Title,and Company Name <br /> Date <br /> (If Owner is not Operator) <br /> Or: Certification by an independent professional engineer,geologist,or environmental assessor who is registered in <br /> the State of California. Certification by a registered professional is optional for Permit-By-Rule and Conditionally <br /> Authorized Generators. Sign and affix stamp. <br /> Signature Name,Title,Registration Number Date <br /> DISC U 51(06199) Please indicate total number of pages._of <br />