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07!11%96 THL' 11:08 FAX 707 747 7705 PHILIP ENVIRO>MIENTAL 10005 <br />.%tc of California - Environmental Protection Agency <br />FACILTY NAME Ripon City Hall <br />IV <br />Department of Toxic Subatantes Control <br />ID NUMBER In Process <br />TEMPORARY HOUSEHOLD HAZARDOUS WASTE <br />COLLECTION FACILITY <br />PERMIT BY RULE NOTIFICATION <br />OPERATOR CERTIFICATION (PUBLIC AGENCY) <br />"I certify under penalty of law that this document and all attachments were prepared under my direction or supervision in accordance <br />with a system designed to assure that qualified personnel properly gather and cvaluatcthe information submitted Based on my inquiry <br />of the person or persons who manage the system. or those directly responsible for gathering the inrormotion, the information is. to the <br />but of my knowledge and belief, true. accurate and complete. I un rw3rc that there we s,gnlficant penalties for submitting false <br />information, including the possibility of flnes and imprisonment for knowing violations." <br />Henry M. Hirata <br />Director of Public Works <br />Opuzor Name (Print m Type) Title <br />Si at c Date Signed <br />DTSC 8464 (9192) Page 4 oro <br />