Pinole's Self Certification Form

Self Certification Form

Self Certification Form

TRASH CAPTURE SELF CERTIFICATION FORM

Property Owner

Property Street Address  

Phone Number  Email Address

APN

The property at the above address is surface draining and has no stormwater inlets on the parcel. I agree to an inspection of my property by the City of Pinole to confirm this certification.  

By checking the box and typing my name below, I am electronically signing this self-certification form.

I certify under the PENALTY OF PERJURY under the law of the State of California that the foregoing paragraph is true and correct.

Property Owner  Date



Security Measure