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08./13/96 TUE 08:58 FAX 707 747 7705 PHILIP ENVIROMENTAL d065 <br />60 1. <br />State of California - Environmental Protection Agency tkpartment of Toxic Subat■nees Control <br />FACILTY NAME Tower Park Marina ID NUMBER CAH777000845 <br />TEMPORARY HOUSEHOLD HAZARDOUS WASTE <br />COLLECTION FACILITY <br />PERMIT BY RULE NOTIFICATION <br />TV. OPERATOR CERTIFICATION (PUBLIC AGENCY) <br />"I certify under penalty of law that this document and all Vachments Were prepared under my direction or supervision in accordance <br />with a ryctcm designed to assure that qualified personnel properly gather and evaluatedte information submitted Based on my inquiry <br />of the person or persons who monase the system, or those directly reepnnsibie for gathering the information, the information is. to the <br />best of my knowledge and belief, true, accumte lmd complete I am aware that there are significant penalties for Submitting false <br />information, including, the possibility, of fines and tmprisnnmcnt for knowing violations." <br />HENRY M. HIRATA PUBLIC WORKS DIRECTOR <br />Operatof Name (Print or Ty pc) Title <br />Signature Date Signed <br />DTSC 8464 (9/92) Page 4 of 4 <br />