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FACILITY NAME Lovelace Materials Recovery Facility <br />ID NUMBER CAH 111000527 <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 <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 <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 />ALISON HUDSON <br />MANAGEMENT ANALYST III <br />Operator Nam Print or Type) Title <br />r_d� U /7 �y <br />Signature Date Sig ed <br />DTSC 8464 (9/92) Page of 4 <br />F&ADMINFORMSTBR FORM <br />