Text · page 110 of 240
Read the whole document on one page (all 240 pages, each with its own heading)
Notice of Intent: Village of East Aurora Appendix K
NIIWYOlttC StA11 DIMR TMI-NT Of- 1.N\llMONMfH1At C-..:ON 'llflVATtON
M s , O per ator Certification Form f or e Repor1s
arDe:8 0-•n•UI ,..,ml1 ,Of"
M1Jnt~ff>al . .:~:t:.:~;,, 0
.;:!:.~'a;:,~~tO~ 0 14-001)
ln.etnJc.tlona
Pltalffle f'9YIOW Pnrt X J uf G? 0 ;,M.oo, bofuro •1~"'"1.1 ttl I fofm /\ itlUMture by
■n un•u!Jianz-.<t pef'WOf1 w"1 d•ln( r>fW'TI'l'I ClOWntQfl
Th•• tom'I musl be 1tgn0<1 by ON1 ot tho followng
1 Fe, ■ ~ l i O O by II r0til)O'llibl0 COfJX)fWtO ofr,c.e,
2 For• pnrtnerslllp: by B gonoral portnor-
3 For a eole propnetorshlp b,' lhe p(Opl1o1e>r
4 For a m.JnOpallty. s101e. f&dernl or othor public egor1ey by a pflncpel exoeut:t...,. affl091"
or ranUng oroctOd official
MS.. Op<trator Name: \/, l1 "-'!)' o[ E.0•J- A,,rQ(G',
eReport Submhulloo Number. HG 1 - E6 rl { _ tJ B y z..1
MS.C Operator C•rtl11eatlon
1certJfy under peno1ty of !aw !hat t,!s dccumont and al' atlAchmenta _,. _ . . . . - m y
dlrect1cn or supervielon In accords nc:9 wllh o sy&tem de1igned to a......-. that .....,._. pet9CWWIIII
pr(lp8(ty gathered and eva1uated the 1nformal'on eubm 11e<J, Based on my lnqulty d ._ S - -
or porsons who manage the sysl8ffl. or lhosa persona clrecUV reaponalt>a for gattwt,,g ._
lnfor,nat.cn, the information aubmllled '•· to the belt of my krowtadQe and t)ella(, - • _,,__
end completa. I am aware lhat lhere ara sl gnlflcanl .,.nal l • f o r ~ . . . . _ ~ ...........
Including ,he posaloillty or nna ■no 1mpriaonmanl for knowing vlolallona.
/.¾Jee OJer(u, p
Name Cp l - prtnl ar type)
(]ff/~
22