Form D Industrial Waste Facility Online Reporting System

FORM D: INDUSTRIAL WASTE FACILITY ONLINE REPORTING SYSTEM. This ESA creates a legally binding obligation upon the parties using the specified data transmission protocols and IWFORS, to ensure that the Certifier (in this document, "Certifier" refers to signers of this document — both the Signatory Authority, and the RO) specifically acknowledges and agrees to each of the following requirements and obligations: (i) Maintain the confidentiality and protect the electronic signature from unauthorized use or compromise, and follow any procedures specified by LACSD for this purpose; (ii) The Certifier is and will be legally bound, obligated, or responsible by use of the assigned electronic signature as by hand-written signature. This ESA has been executed by the parties to evidence their mutual intent to follow LACSD procedures to create binding regulatory reporting documents using electronic transmission and receipt of such records, consistent with the provisions of 40 C.F.R. Part 3 (CROSS-MEDIA ELECTRONIC REPORTING Requirements, CROMERR). Acceptance and execution of this ESA by LACSD shall be evidenced by the issuance of a personal identification number (PIN) to the Certifier. Consistent with 40 C.F.R. Part 3 electronic signatures under this ESA shall have the same force and effect as a written signature. This form will remain on file with LACSD. www.FormsWorkflow.com