WA ST Dept of Ecology 3/3/2020 - Laserfiche WebLink

Facility Information Continued Certification Statement "I certify under penalty of law that this document and all attachments were prepared under my direction or supervision in accordance with a system designed to assure that qualified personnel properly gather and evaluate the information submitted. Based on my inquiry of the person or persons who manage the system, or those persons directly responsible for gathering the information, the information submitted is, to the best of my knowledge and belief, true, accurate, and complete. I am aware that there are significant penalties for submitting false information, including the possi ' ' 'ne and imprisonment for knowing violations." Signature of Responsible Official Title 3/3 Da e Must be signed by the Responsible Official;see WAC 173-308-310(10)(a). Submission Instructions Please note, you MUST submit multiple copies, and deadlines vary depending on submission format. Deadlines by submission type: By Mail: Postmarked no later than 11:59 PM Monday March 9th, 2020. In Person: Delivered to office no later than 5:00 PM Monday March 9th, 2020. By Email (when acceptable, see submission instructions below): Received no later than 11:59 PM Monday March 9th, 2020. Submission Type Location Original Hard Copy Regional Office(see regional contact and address information below) Copy(electronic Other regions where your biosolids,sewage sludge,or septage will be treated, preferred) stored, disposed, or land applied. (see regional contact and address information below) Copy(electronic Headquarters Office(see Region Contact Information and Addresses table preferred) below.) Copy(electronic You MUST send a copy to Local Health Jurisdictions where your biosolids,sewage preferred) sludge, or septage will be treated,stored, disposed,or land applied, unless the Health Jurisdiction has declined to receive a copy. Office of the City Attorney A ST. APPROVED AS TO FORM David C. Hall, City Attorney City Clerk ECY 070-300(Revised February 2020)