Person Responsible for
the Biennial Certification:
(The following certification shall be signed according
to N.J.A.C. 7:26E-1.5, N.J.A.C. 7:26C-1.2 and the
covenant not to sue (if issued) as follows:
- For a Limited Liability Company a member
of the Limited Liability Company; or
- For a Corporation by a person authorized
by a resolution of the board of directors to sign
the document. A copy of the resolution, certified
as a true copy by the secretary of the corporation,
shall be submitted along with the certification;
or
- For a partnership or sole proprietorship,
by a general partner or the proprietor, respectively;
or
- For a municipality, State, federal or other
public agency by either a principal executive officer
or ranking elected Official.
“I certify under penalty of law that I have
personally examined and am familiar with the information
submitted herein and all attached documents, and
that based on my inquiry of those individuals immediately
responsible for obtaining the information, to the
best of my knowledge I believe that the submitted
information is true, accurate, and complete. I am
aware that there are significant civil penalties
for knowingly submitting false, inaccurate, or incomplete
information and that I am committing a crime of
the fourth degree if I make a written false statement,
which I do not believe to be true. I am also aware
that if I knowingly direct or authorize the violation
of any statute, I am personally liable for the penalties.”
I also understand that in order to maintain the
benefits of the Covenant Not to Sue, the engineering
and institutional controls (as applicable) must
be evaluated and maintained to remain protective
of public health and safety and of the environment.
Based upon all of the information that I have provided
above, I hereby certify that the remedial action(s)
for which this Classification Exception Area was established
remain protective of public health and safety and
of the environment.
Name (print or type): John Doe__________________________________
Title: President_______________________________________________
Signature: John Doe___________________________________________
Name of Limited Liability Company, Corporation or
General or Limited Partnership:
ABC Company_____________________________________________
Date: August 5, 2003_______________________________________
Sworn to & Subscribed before me
On this _____Fifth____________
day of August___________
2003______
I. M. Authorized___________________________
Notary |
Forms
II.
CEA Protectiveness Evaluation
