Pledge Of Revenue Requirements Page 3

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State of California
Department of Resources Recycling and Recovery (CalRecycle)
ANNUAL CERTIFICATION OF PLEDGED REVENUE FOR
__________________________________________ LANDFILL
SOLID WASTE FACILITY NO. _________________
I hereby certify thatthe pledged revenue continues to be available when needed and will cover
the postclosure maintenance costs and/or corrective action costs shown in the Pledge of Revenue
Requirements Form and as required by Title 27, California Code of Regulations, Division 2,
Subdivision 1, Chapter 6.
Signature
Date
Typed or Printed Name
Title and Public Agency
Phone Number
Please sign and return this Certification to California Department of Resources Recycling and Recovery (Cal Recycle)
P.O. Box 4025, Sacramento, California 95812-4025,
and to the attention of the Manager, Financial Assurances Section, MS 10A-18.
CalRecycle 114 (02/2010)
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