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Attachment B. <br />Part 3. Certification (Read and sign after completing all sections.) <br />I certify under penalty of law that I have personally examined the information submitted in this <br />and all attached documents. Based on my inquiry of those individuals responsible for obtaining <br />the information, I certify that the submitted information is true, accurate, and complete, and that <br />those portions of the substantiation claimed as confidential would, if disclosed, reveal the <br />chemical identity being claimed as trade secret, or would reveal other confidential business or <br />trade secret information. I acknowledge that I may be asked by the Eugene Fire Marshal to <br />provide further detailed factual substantiation relating to this claim of trade secrecy, and certify <br />to the best of my knowledge and belief that such information is available. I understand that if the <br />Fire Marshal determines that this trade secret claim is inappropriate, then the chemical must be <br />reported. I understand that if I believe a determination by the Fire Marshal is incorrect, I may <br />appeal that determination to the Toxics Board, stating the reasons for the appeal. The Toxics <br />Boards decision is final, except that under Section 8.1.B of the Charter Amendment, any person <br />may appeal the decision to the Circuit Court for Lane County. <br />Name and Official Title of owner, facility operator, or senior management official: <br />_______________________________ _____________________________________ <br />Name Title <br />______________________________________ ______________________ <br />Signature Date Signed <br />STATE OF OREGON ) <br />) ss. <br />County of Lane ) <br />This instrument was acknowledged before me on the ______ day of <br />__________________, 20_____, by _______________________. <br />____________________________________ <br />Notary Public for Oregon <br />My commission expires: ________________ <br />This form is to be filed with Eugene Toxics Program Staff c/o Fire Marshal (1705 W. 2 nd <br />Ave.,Eugene,OR 97402) prior to the procurement or production of the trade secret <br />chemical being claimed. <br />- 47- <br />