California Code of Regulations
Title 14 - Natural Resources
Division 2 - Department of Conservation
Chapter 5 - Division of Recycling
Subchapter 9 - Community Service Programs
Article 3 - Individual Commingled Rate
Form Afd (01/01)

Universal Citation: 14 CA Code of Regs Afd (01/01)
Current through Register 2024 Notice Reg. No. 38, September 20, 2024

AFFIDAVIT for the Individual Commingled Rate Survey 20 _____ (AFD (01/01))

___________________________

Program Name:

___________________________

Certification/Registration Number(s):

To the best of my knowledge, this Individual Commingled Rate Survey data and information is complete, accurate, and consistent with the Application approved by the Department of Conservation's Division of Recycling (Division). I also verify that all information provided on all Daily Data Collection Sheets and Weekly Summary Sheets submitted during the annual survey period was obtained through the survey methodology approved by the Division.

Name: ___________________________
Signature: ___________________________
Title: ___________________________
City, County: ___________________________
Date: ___________________________

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