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IV. <br />FACILITY NAME San Joaquin County Fairgrounds ID NUMBER CAH I 11000344 <br />TEMPORARY HOUSEHOLD HAZARDOUS WASTE <br />COLLECTION FACILITY <br />PERMIT BY RULE NOTIFICATION <br />OPERATOR CERTIFICATION (PUBLIC AGENCY) <br />"I certify under penalty of Iaw that this document and all attachments were prepared under my direction or supervision in <br />accordance with a system designed to assure that qualified personnel properly gather and evaluate the information submitted. ) <br />Based on my inquiry of the person or persons who manage the system, or those directly responsible for gathering the j <br />information, the information is, to the best of my knowledge and belief, true, accurate and complete. I am aware that there <br />are significant penalties for submitting false information, including the possibility of fines and imprisonment for knowing <br />violations." <br />Steven Winkler <br />Operator Name (Print r Type) <br />Siat <br />Deputy Director/Operations <br />Title <br />Date Signed <br />)TSC 8464 (10/97) <br />i/ADMINFOR.MSTBR FORM Page 4 of 4 <br />