Ordinance No. 20518 - Laserfiche WebLink

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Part I Certification (Read and sign after completing all sections.) I certify under penalty of law that I have personally examined the information submitted in this and all attached documents. Based on my inquiry of those individuals responsible for obtaining the information, I certify that the submitted information is true, accurate, and complete, and that those portions of the substantiation claimed as confidential would, if disclosed, reveal the chemical identity being claimed as trade secret, or would reveal other confidential business or trade secret information. I acknowledge that I may be asked by the Eugene Fire Marshal to provide further detailed factual substantiation relating to this claim of trade secrecy, and certify to the best of my knowledge and belief that such information is available. I understand that if the Fire Marshal determines that this trade secret claim is inappropriate, then the chemical must be reported. I understand that if I believe a determination by the Fire Marshal is incorrect, I may appeal that determination to the Toxics Board, stating the reasons for the appeal. The Toxics Board's decision is final, except that under Section 8.13 of the Charter Amendment, any person may appeal the decision to the Circuit Court for Lane County. Name and Official Title of owner, facility operator, or senior management official: Name Signature Title Date Signed STATE OF OREGON County of Lane ) ss. This instrument was acknowledged before me on the day of 20 , by Notary Public for Oregon My commission expires: _ This form is to be filed with Eugene Toxics Program Staff c/o Fire Marshal (1705 W. 2 Ave., Eugene, OR 97402) prior to the procurement or production of the trade secret chemical being claimed. -47-