TRANSFER OR SALE OF PERCHLOROETHYLENE CERTIFICATE
This is to certify that the perchloroethylene transferred or sold on or after ________________ (month) (day) (year)
from ___________________________________________________ (name) is not to a dry-cleaning facility.
This certificate is to continue in force until revoked by written notice to the supplier.
Under the penalty of perjury, I declare that I have read the foregoing, and the facts alleged are true.
Purchaser __________________________________________________________________________________________________
Address ___________________________________________________________________________________________________
By _______________________________________________________________________________________________________
(Signature)
Date _________________________
Fla. Admin. Code Ann. R. 12B-12.0031
Rulemaking Authority 212.18(2), 213.06(1), 376.75(9)(b) FS. Law Implemented 376.301(14), 376.75 FS.
New 3-18-96, Amended 1-5-00, 6-28-05.