Cal. Code Regs. Tit. 14, div. 2, ch. 5, subch. 9, art. 3, form Afd (01/01)
Current through Register 2025 Notice Reg. No. 2, January 10, 2025
AFFIDAVIT for the Individual Commingled Rate Survey 20 _____ (AFD (01/01))
___________________________
Program Name:
___________________________
Certification/Registration Number(s):
To the best of my knowledge, this Individual Commingled Rate Survey data and information is complete, accurate, and consistent with the Application approved by the Department of Conservation's Division of Recycling (Division). I also verify that all information provided on all Daily Data Collection Sheets and Weekly Summary Sheets submitted during the annual survey period was obtained through the survey methodology approved by the Division.
| Name: ___________________________ | |
| Signature: ___________________________ | |
| Title: ___________________________ | |
| City, County: ___________________________ | |
| Date: ___________________________ |
Cal. Code Regs. Tit. 14, div. 2, ch. 5, subch. 9, art. 3, form Afd (01/01)