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<br />If] <br />i <br />1...1 <br />1 <br />i <br /> <br />MATERIALS BALANCE REPORT CERTIFICATION <br /> <br />f1 <br />fJ <br />r1 <br />II <br />11 <br /> <br />TOXICS RIGHT-TO-KNOW PROGRAM <br />CITY OF EUGENE <br /> <br />REPORTING YEAR 2000 <br /> <br />Facility Name <br /> <br />Facility ID No. <br /> <br />f 1 <br />i ! <br />f..I <br /> <br />Facility Address <br /> <br />"I" t <br />4 1 <br /> <br />Mailing Address <br /> <br />: I <br /> <br />Person Completing Report (not to be released to public): <br /> <br />(name) <br /> <br />(title) <br /> <br />(phone) <br /> <br />, I <br /> <br />I hereby certify that the information contained in the accompanying electronic materials <br />balance report is complete and accurate to the best of my knowledge, based on readily <br />available information. <br /> <br />Signature <br /> <br />Date <br /> <br />Printed Name <br /> <br />Title <br /> <br />B-3 <br />