Form ECY070-576 "Transfer Report Signature and Submittal Form" - Washington

What Is Form ECY070-576?

This is a legal form that was released by the Washington State Department of Ecology - a government authority operating within Washington. As of today, no separate filing guidelines for the form are provided by the issuing department.

Form Details:

  • Released on December 1, 2017;
  • The latest edition provided by the Washington State Department of Ecology;
  • Easy to use and ready to print;
  • Quick to customize;
  • Compatible with most PDF-viewing applications;

Download a fillable version of Form ECY070-576 by clicking the link below or browse more documents and templates provided by the Washington State Department of Ecology.

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Download Form ECY070-576 "Transfer Report Signature and Submittal Form" - Washington

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Transfer Report Signature and Submittal Form
TRSS
This form is for the submission of emission
reduction units (ERUs) by a facility
covered by the Clean Air Rule.
Mail a signed copy to:
Washington State Department of Ecology
Air Quality Program
For Ecology
Date
Clean Air Rule
Use Only
Received:
P.O. Box 47600
Reviewed
Entered
Verified
Olympia, WA 98504-7600
Transfer Information
Transfer ID
Facility Information
EPA GHGRP ID
Name
Physical Address
City/State/Zip
Signer Information
Name
Organization
Mailing Address
City/State/Zip
Phone Number (Ext)
Email Address
Certification Statement – To be completed by the Designated Representative or
Alternate Designated Representative
I am authorized to make this transfer on behalf of the owners and operators of the facility
listed above. I certify under penalty of law that the statements and information submitted
to Ecology related to this transfer are true, accurate and complete. I am aware that there
are significant penalties for submitting false statements and information or omitting
required statements and information, including the possibility of fine or imprisonment.
Signature – Sign and date on the lines below
Signature
Date
To request ADA accommodation, call 360-407-6800, 711 (relay service), or 877-833-6341 (TTY).
Page 1
ECY 070-576
Transfer Report Signature and Submittal Form
TRSS
This form is for the submission of emission
reduction units (ERUs) by a facility
covered by the Clean Air Rule.
Mail a signed copy to:
Washington State Department of Ecology
Air Quality Program
For Ecology
Date
Clean Air Rule
Use Only
Received:
P.O. Box 47600
Reviewed
Entered
Verified
Olympia, WA 98504-7600
Transfer Information
Transfer ID
Facility Information
EPA GHGRP ID
Name
Physical Address
City/State/Zip
Signer Information
Name
Organization
Mailing Address
City/State/Zip
Phone Number (Ext)
Email Address
Certification Statement – To be completed by the Designated Representative or
Alternate Designated Representative
I am authorized to make this transfer on behalf of the owners and operators of the facility
listed above. I certify under penalty of law that the statements and information submitted
to Ecology related to this transfer are true, accurate and complete. I am aware that there
are significant penalties for submitting false statements and information or omitting
required statements and information, including the possibility of fine or imprisonment.
Signature – Sign and date on the lines below
Signature
Date
To request ADA accommodation, call 360-407-6800, 711 (relay service), or 877-833-6341 (TTY).
Page 1
ECY 070-576