Certification of Submittals

(1) Any person undertaking a response action shall include the following written declaration when expressly required by 310 CMR 40.0000, including, but not limited to, with any Release Notification Form, Status Report, Completion Statement, Phase V Report, Permanent or Temporary Solution Statement, Tier Classification Submittal, LSP Evaluation Opinion, Tier Classification Extension Submittal, Tier Classification Transfer Submittal, Periodic Review Opinion, Final Inspection Report, Construction Plan and Specifications, Operation, Maintenance and/or Monitoring Plan, Bill of Lading, Downgradient Property Status Submittal, Modification of Downgradient Property Status Submittal, or other LSP Opinion submitted to the Department pursuant to the MCP: "I, _______________, attest under the pains and penalties of perjury (i) that I have personally examined and am familiar with the information contained in this submittal, including any and all documents accompanying this submittal, (ii) that, based on my inquiry of those individuals immediatelyresponsible for obtaining the information, the material information contained in this submittal is, to the best of my knowledge and belief, true, accurate and complete, and (iii) that I am fully authorized to make this attestation on behalf of the person or entity legally responsible for this submittal. I/the person or entity on whose behalf this submittal is made am/is aware that there are significant penalties, including, but not limited to, possible fines and imprisonment, for willfully submitting false, inaccurate or incomplete information." By: ________________________ Signature Date ________________________ Title For:_________________________ Name of person or entity (2) The written declaration in 310 CMR 40.0009(1) required of a person undertaking a response action shall be made by the highest ranking individual(s) having day-to-dayresponsibility for the performance of the response action which is the subject of the submittal. The written declaration shall not be made by the Licensed Site Professional engaged or employed by the RP, PRP or Other Person to render Professional Services with respect to the site, unless the Licensed Site Professional's client or employer has authorized him or her in writing to act as his or her agent for the purpose of making the written declaration. (3) The written declaration required by 310 CMR 40.0009(1) shall include the signature of each person making the submittal, the date on which each such person makes his or her attestation and the position or office of each such person. (4) Each submittal filed with the Department pursuant to 310 CMR 40.0000 shall be accompanied by a completed transmittal form established by the Department for such purposes. (5) No person filing a submittal required by M.G.L. c. 21E or 310 CMR 40.0000 with the Department shall alter, modify or nullify the contents of the transmittal form established by the Department for such purposes without the express approval of the Department. 40.0009: continued (6) The Department may require any person providing information required to be submitted to the Department pursuant to M.G.L. c. 21E, 310 CMR 40.0000, or any order issued or determination made by the Department pursuant to M.G.L. c. 21E and 310 CMR 40.0000, to include the written declaration set forth in 310 CMR 40.0009(1).