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FACILITY NAME Taft Communis L__.cer Parking Lot <br />ID Ntr "SER CAH l 11000612 <br />TEMPORARY HOUSEHOLD HAZARDOUS WASTE <br />COLLECTION FACILITY <br />PERMIT BY RULE NOTIFICATION <br />N (PUBLIC AGENCY) <br />IV. OPERATOR CERTIFICATIOunder my direction or supervision in <br />"I certify under p y qualified ttac el properly gather and evaluate the informationsubmitted. <br />pe of law that this document and allp ttachments were prepared <br />or those directly responsible for gathering <br />he <br />accordance with a system designed o assure that q complete. I am aware that there <br />Based on my inquiry of the person or persons who <br />and bel efmanage the e true, accurate and comp imprisonment for knowing <br />information, the information is, to the best of my <br />cant penalties for submitting false information, including the possibility of fines and ImP <br />are slantfi <br />violations." erations <br />Deputy Director/Op <br />Steven Winkler Title <br />Operator Name (Print or Type). <br />Date Signed <br />Signa re <br />page 4 of 4 <br />D/ADMIN ORMSIP13ROFORM) <br />