8 CAR pt. 62, Appendix D. Affidavit of Dismissal

APPENDIX D AFFIDAVIT OF DISMISSAL Affidavit of Dismissal State of Arkansas ) ) County of ____________ ) Before me, the undersigned authority, personally appeared ___________________, who, being by me duly sworn, stated as follows: 1. My name is ______________________. I am of sound mind, capable of making this affidavit, and personally acquainted with the facts herein stated. 2. I am currently licensed as an Environmental Officer by the Environmental Compliance Resource Program of the Arkansas Department of Energy and Environment, Division of Environmental Quality. 3. Pursuant to Ark. Code Ann. § 8-6-2001 et seq., on ________________, I issued a citation, specifically citation no. ______________ , to _______________________________ (alleged violator) for prohibited conduct concerning the following physical address and location: _____________________________________________________________________________. 4. Pursuant to Ark. Code Ann. § 8-6-2016(a), I notified the alleged violator that they had until ________________ to remediate the environmental violation. 5. Upon reviewing the attached cost statement, issuing the attached inspection report of the site property, and verifying that the environmental violations have been remediated, the environmental citation is withdrawn, and any hearing concerning this matter is unnecessary. Further Affiant Sayeth Not. ____________________________ Name SWORN AND SUBSCRIBED before me on the ___ day of ________________ 20___. _________________________ ___________________________ My commission expires: Notary Public, State of Arkansas