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Virginia Administrative Code
Title 9. Environment
Agency 25. State Water Control Board
Chapter 590. Petroleum Underground Storage Tank Financial Responsibility Requirements
11/21/2024

9VAC25-590-260:8. APPENDIX VIII. CERTIFICATION OF ACKNOWLEDGMENT.

APPENDIX VIII. CERTIFICATION OF ACKNOWLEDGMENT.

[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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