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.AUL -15-1996 17:39 S.J. COUNTY SOLID WASTE 209 4683076 P.OS <br />Sbt" of Culifofmtt - Eevironmeuual ProWbon Agency Dep nmeat of Toxic 5ubseanea Control <br />FACILTY NAME Ripon City Hall ID NUMBER in Process <br />TEMPORARY HOUSEHOLD HAZARDOUS WASTE <br />COLLECTION FACILITY <br />PERMIT BY RULE NOTIFICATION <br />1V. OPERATOR CERTIFICATION (PUBLIC AGENCY) <br />I certify under petuity of law 1Ax[ tltis dot ttimm and rll 7Richtraen0 wcrc prepamd undo my direction or supeevmsion in wcordance <br />With a sy teff designed w assure that gu3iified personnel pmperly gatfia and cvaluamihc infDmiauon submirted_ based on aty inquiry <br />Of the person or persons who manage thesystem. or thox diaet0v responsible for gathOring the inrormmion. the information is. to the <br />best or'my knowiefte and belief. true, accurate and complete. 1 am aware that 11aeR are 549ntficm1 paraltiei for iubrrtitting false <br />ia2ofrna6w, including the possibility of !ices tvtd imprOwnmenl for knowing violmlons.' <br />Henry K. Hirata <br />opaaor Name (Print yr Tv <br />pe) <br />s- <br />DTSC 6464 (9192) <br />Director of Public Works <br />Title <br />-2/j7/0 �, <br />rim Signed <br />Page 4 of 4 <br />TOTAL P.Ocn <br />