Virginia Administrative Code
Title 9 - ENVIRONMENT
Agency 25 - STATE WATER CONTROL BOARD
Chapter 590 - PETROLEUM UNDERGROUND STORAGE TANK FINANCIAL RESPONSIBILITY REQUIREMENTS
Section 9VAC25-590-260:8 - APPENDIX VIII. CERTIFICATION OF ACKNOWLEDGMENT

Universal Citation: 9 VA Admin Code 25-590-260-8
Current through Register Vol. 41, No. 3, September 23, 2024

[Note: The instructions in brackets are to be replaced by the relevant information and the brackets deleted.]

State of....

County of....

On this [date], before me personally came [owner or operator] to me known, who, being by me duly sworn, did depose and say that she/he resides at [address], that she/he is [title] of [corporation], the corporation described in and which executed the above instrument; that she/he knows the seal of said corporation; that the seal affixed to such instrument is such corporate seal; that it was so affixed by order of the Board of Directors of said corporation; and that she/he signed her/his name thereto by like order.

[Signature of Notary Public]

[Name of Notary Public]

My Commission expires:

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