I, _______________(authorized individual name), ____________(position title), hereby certify that I am the owner or authorized representative of the solid waste containerized storage facility, _________________(facility name), located at _________________(location address); that I am aware of ss. NR 502.04 and 502.05, Wis. Adm. Code applicable to the facility; and that the facility is in compliance with the codes.
____________________________ _________________
(signature of authorized individual) (signature date)
Wis. Admin. Code Department of Natural Resources NR 502.05