Colorado Department of Public Health and Environment

VSQG waste collection facility annual recertification

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For the purposes of this form, the Colorado Department of Public Health and Environment accepts your typed name, title and date as an electronic signature equivalent to your valid signature on a paper copy of the form. As such, this electronically completed form bears the same rights and responsibilities as a hand-signed form.
I certify that:
1. This facility is in compliance with the requirements for Large Quantity Generators except as modified by the VSQG Waste Collection Facility Policy including, but not limited to: *
2. The information contained in this submittal is, to the best of my knowledge, true, accurate and complete in all respects; and
3. I am fully authorized to make this certification on behalf of this facility.
I am aware that there are significant penalties including, but not limited to, possible fines and imprisonment for willfully submitting false, inaccurate or incomplete information.
Select the Submit button to send your form to the department. You will receive an email confirmation that we received your form. Your authorization request is not complete until you SUBMIT your data.
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