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CERTIFICATE OF GROUP HEALTH PLAN COVERAGE

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CERTIFICATE OF GROUP HEALTH PLAN COVERAGE

You may use this certificate as evidence of your creditable coverage to reduce the length of any preexisting condition exclusion if you enroll in another plan. Right to get special enrollment in another plan. Under HIPAA, if you lose your group health plan .

http://www.dol.gov/ebsa/hipaamodelnotice.doc

Date added: October 6, 2011 - Views: 93

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COMPLIANCE STATEMENT - Federal Aviation Administration

COMPLIANCE STATEMENT (SINGLE ... THE CERTIFICATE HOLDER will comply with the certification and operations specifications requirements in subpart C of this part and will conduct ... (Initial and recurrent portions of training program are submitted for initial approval with this letter). 135.335 ...

http://www.faa.gov/licenses_certificates/airline_certification/media/SPLOC.doc

Date added: August 7, 2011 - Views: 232

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Sample Certification Letter - Susan Combs - Texas Comptroller ...

Printed on Corporation’s Letter Head. Date. TXMAS Program. Texas Comptroller of Public Accounts. 1711 San Jacinto Blvd. Austin, TX 78701. Subject: Certification of Prices, Terms and Conditions. To Whom It May Concern: ... Sample Certification Letter ...

http://www.window.state.tx.us/procurement/prog/txmas/edocs/CertificationLetter.doc

Date added: October 21, 2011 - Views: 369

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Sample LOC 145 - Stache Air

This is a sample only and you must use the new part 145 rules when completing the letter of compliance.

http://www.stacheair.com/data/At%20Work%209B%20Repair%20Station%20CD/Handouts/Letter%20of%20Compliance%20Sample%201.doc

Date added: March 13, 2012 - Views: 26

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SUMMARY FORM:COMPLIANCE CERTIFICATION - Commission on Colleges

Submitted with Compliance Certification for Initial ... (Check all that apply) Diploma or certificate program(s) requiring less than one year beyond Grade 12. Diploma or ... that has terminated the institution’s accreditation (include the date, reason, and copy of the letter of ...

http://www.sacscoc.org/forms/principle/Summary%20Form%20for%20Commission%20Review.doc

Date added: February 2, 2012 - Views: 16

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Sample Letter to Successful Bidder - RI Office of Library and ...

Title: Sample Letter to Successful Bidder Subject: RI Public Library Construction Reimbursement Program Author: RI Office of Library and Information Services

http://www.olis.ri.gov/grants/construction/regulations/appendix_iSample.doc

Date added: September 24, 2011 - Views: 18

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SAMPLE - Stache Air

Letter of Compliance ... as a certified repair station until granted a certification per this paragraph or advertise as such prior to said certificate approval. An application for repair station, ... SAMPLE: Limited Airframe: Landing Gear.

http://www.stacheair.com/data/At%20Work%209B%20Repair%20Station%20CD/Handouts/145%20Compliance%20Sample%202.doc

Date added: March 16, 2012 - Views: 17

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SAMPLE - Massachusetts

The Appendix reference section includes a link to a sample letter contract for engaging design services for small projects where the basis of payment is a fee ... A sample Certificate of Insurance which is to be provided to the LHA by ... Certificate of Compliance with Bidding Laws.

http://www.mass.gov/hed/docs/dhcd/ph/small-projects/dhcdsmallprojectsguide.doc

Date added: October 6, 2012 - Views: 272

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www.ct.gov

SAMPLE VERIFICATION LETTER TO RECEIVE THE CERTIFICATION FROM DOH. NOTE:The Statute requires that the DOH Commissioner issue compliance certificate by October 1st annually.

http://www.ct.gov/doh/lib/doh/doh/opm/sample_verification_letter_to_receive_the_certification_from_doh.docx

Date added: November 6, 2013 - Views: 1

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SAMPLE OF CERTIFICATION MEMORANDUM - DTIC

SUBJECT: Certification of Rule Compliance with Executive and Legislative Requirements. Request the attached rule be published in the Federal Register. Certifications follow: Executive Order 12866, ... SAMPLE OF CERTIFICATION MEMORANDUM ...

http://www.dtic.mil/whs/directives/corres/writing/FR_Cert_Memo.doc

Date added: March 6, 2012 - Views: 3

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Professional Letter - ACB - FCC Certification Services for ...

Certifications or Registrations sample letter) Canadian Representative. Company Name: CN Number: Contact Name: Street Address: City/Province/Zip: Telephone No: Fax No: ... (see Annex A) and a properly signed declaration of compliance (see Annex B). However, ...

http://acbcert.com/documents/misc-docs/ACB-Form-IC-Application-Letters.doc

Date added: December 23, 2012 - Views: 7

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SAMPLE FORMAL APPLICATION LETTER - Federal Aviation ...

Attachment 12. Compliance Statement. ... SAMPLE FORMAL APPLICATION LETTER(Continued. ... This system must enable the center to demonstrate compliance with the requirements of their certificate, contractual requirements of their customers, ...

http://www.faa.gov/pilots/training/part_142/media/formal_appltr.doc

Date added: August 24, 2011 - Views: 1353

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DEPARTMENT OF HUMAN SERVICES - New Jersey

Division of Contract Compliance & Equal Employment Opportunities in Public Contracts. P.O. Box 209. ... If the Provider Agency does not submit either the Federal Affirmative Action Plan Approval letter or a current Certificate of Employee Information Report within the required time frame, ...

http://www.nj.gov/humanservices/ocpm/policies/InformationMemoranda/IM_P07_1.DOC

Date added: January 28, 2012 - Views: 11

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SAMPLE SUMMARY LETTER - California - Department of Housing ...

Regulatory Agreement Compliance. 8. ... SAMPLE SUMMARY LETTER. Residential Lease. Finding # 4: The current version of the “Lease Agreement” does not address HOME Regulations and prohibited lease terms. Required Corrective Action:

http://www.hcd.ca.gov/fa/home/SAMPLE-SUMMARY_LETTER.doc

Date added: October 7, 2011 - Views: 313

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Standard Letter of Credit Template — ISP 98

The Bank will honor your request(s) drawn under and in compliance with this Letter of Credit without inquiring whether you have a right, ... To That Certain Irrevocable Standby Letter of Credit . CERTIFICATE. The undersigned hereby certifies to [NOTE - Insert Name of Bank]

http://www.gastransmissionnw.com/downloads/documents/letter_of_credit.doc

Date added: September 13, 2011 - Views: 474

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Giving Your Tenant Notice to Vacate - Montana

committed some other non-compliance or violation of the rental agreement. ... It is a good idea to mail the letter by first-class mail with a Certificate of Mailing. The post office will charge you more for the Certificate of Mailing, but it is worth it.

http://courts.mt.gov/content/library/forms/landlord/vacate

Date added: October 6, 2011 - Views: 378

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The Department of Public Works - Connecticut

To issue sample documents to aid in the bidding and construction phase of a project. ... require a letter, signed by the Agency's Representative and submitted to John Nolan, ... shall submit to DPW's Special Projects Unit a "Certificate of Compliance" form, ...

http://www.ct.gov/dpw/lib/dpw/Agency_Admin_Project_Procedures.doc

Date added: November 23, 2011 - Views: 34

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Certification of No Records - The University of Tennessee ...

Title: Certification of No Records Author: Administrator Last modified by: HIM Created Date: 12/11/2002 8:58:00 PM Company: Univ of TN, Health Info Mgmt

http://www.uthsc.edu/compliance/hipaa_policies_procedures/certificate%20no%20records.doc

Date added: January 28, 2012 - Views: 23

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Fall Protection Certificate of Training - N.C. Department of ...

FALL PROTECTION CERTIFICATE OF TRAINING. WELCOME! This sample program is provided to assist you as an employer in developing programs tailored ... This document is provided as a compliance aid, but does not constitute a legal interpretation of OSHA Standards, nor does it replace the need to ...

http://www.nclabor.com/osha/consult/sampleprograms/FallProtectionCert.doc

Date added: October 26, 2011 - Views: 22

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EEOC FORM - Equal Employment Opportunity Commission

... ADR effectiveness, or other compliance issues *Statement of Establishment of Continuing Equal Employment Opportunity Programs [FORM 715-01 PART F] ... Copy of letter to complainant acknowledging receipt from EEOC of remanded case. 2.

http://www.eeoc.gov/federal/directives/715instruct/partsa-j.doc

Date added: October 25, 2011 - Views: 153

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City of San Antonio

Provide a flex zoning porch exemption certificate when applicable. Two identical sets of construction documents, drawn to scale. ... Letter of compliance from the foundation engineer. 19 Expiration of Plan Review and Permits.

https://webapps1.sanantonio.gov/dsddocumentcentral/upload/Residential%20Building%20Permit%20App.doc

Date added: November 14, 2011 - Views: 18

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Statement of Management Policy for Fleet Safety

A current certificate or proof of insurance must be kept in the employee’s file. ... will be responsible for evaluating the applicability of DOT regulations to this company’s operations and ensure compliance with those regulations. ... Employee will receive a letter of reprimand.

http://www.cbs.state.or.us/osha/pdf/pubs/forms/vehicle_safety_sample_program.doc

Date added: March 23, 2012 - Views: 194

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8900.1 Vol. 2, Ch 4, Sec 1 - Federal Aviation Administration

Sample Letter of Compliance, Applicable Sample of OpSpecs, ... a statement that the letter serves as a formal application for either an air carrier certificate or an operating certificate. The letter must contain the full and official name of the applicant.

http://fsims.faa.gov/wdocs/8900.1/v02%20air%20op%20&%20agency%20cert/chapter%2004/02_004_001.doc

Date added: February 19, 2014 - Views: 8

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Sample Wrap Document (Editable) - SelectHealth

Accompanying this sample is a cover letter explaining the purpose of the sample and how it can assist the ... plan that is specific to the employer and is not contained in the Certificate of Coverage supplied by ... Administrator and is not responsible for your compliance with ...

http://selecthealth.org/Forms%20and%20Documents/Brokers/Sample%20Wrap%20Document_SPD%20requirements.docx

Date added: October 8, 2011 - Views: 65

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www.illinoisprobono.org

Sample Pleadings (see also g:\teams\family\brief and form bank) CLSP. Certificate for Dissolution. Domestic Relations Cover Sheet. Petition for Dissolution. ... Certificate of Compliance. Sample Letters to client. Other forms of discovery. Subpoenas. 201(k) Notice.

http://www.illinoisprobono.org/calendarUploads/0032822004%20New%20Attorney%20Training%20Index.doc

Date added: January 27, 2012 - Views: 8

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Beneficial Occupancy Letter - National Park Service

Failure to list any item of work shall not relieve the contractor of responsibility for compliance with the terms of the contract. ... Beneficial Occupancy Letter Subject: Beneficial Occupancy Letter Author: NPS Keywords: Beneficial Occupancy Letter Description:

http://www.nps.gov/dscw/upload/BeneficialOccupancyLetter_8-25-06.doc

Date added: April 11, 2012 - Views: 5

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CNA Reinstatement Package - Virginia

... a letter of prognoses from any substance abuse or other counselors and/or discharge summaries from ... compliance with treatment, and your ability to ... If name has changed since receiving your MOST CURRENT certificate to practice as a certified nurse aide or advance ...

http://www.dhp.virginia.gov/Forms/nursing/CNA/Reinstatement_package.doc

Date added: December 16, 2011 - Views: 43

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[COVER PAGE LETTER TO VENDOR] - New York State Office of ...

COVER LETTER TO VENDOR ... Compliance to national or industry standards. 2.3 Other Technical Requirements. ... Any exceptions or objections to the terms, conditions, and requirements of this RFP, including any SAMPLE CONTRACT included as an Appendix, ...

http://www.ogs.state.ny.us/purchase/BidTemplate/RfpTemplate.doc

Date added: August 9, 2011 - Views: 579

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portal.hud.gov

6. Operator Lease, Memorandum of Lease, & Estoppel Certificate, (if applicable) (Exhibit 5-11) 7. Master Lease (if applicable) (Exhibit 5-12) 8. ... Evidence of compliance (zoning, building, etc.) (Exhibit 8-5) ... Letter of commitment from tax credit syndicator or investor ...

http://portal.hud.gov/hudportal/documents/huddoc?id=FHA_DOC_87.doc

Date added: October 22, 2011 - Views: 20

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(Sample of Letter of Authorisation) - Singapore Customs

... Manifest Compliance Officer . Fax: 62512342. Email: [email protected] Dear Sir/Madam. LETTER OF AUTHORISATION. This is to inform you that [state the authorized person name and his/her NRIC number] ... (Sample of Letter of Authorisation) Author: cedkgaa Last modified by: scuser

http://www.customs.gov.sg/mrs/Sample_Letter_of_Authorisation.doc

Date added: October 20, 2011 - Views: 1546

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Tobacco-Free Certification - Alcohol, Tobacco & Other Drug ...

compliance requirement, your agency is not eligible to apply for TUPE funding from the Cigarette and Tobacco Products Surtax Fund. ... Sample Assurance Letter. TYPE ON AGENCY LETTERHEAD. To: Coordinated School Health and Safety Office.

http://www.cde.ca.gov/ls/he/at/documents/tobaccofreecert.doc

Date added: October 18, 2011 - Views: 11

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Sample Request for Proposal - Pages - Home

SAMPLE REQUEST FOR PROPOSAL ... The financial and compliance audit will cover federal, state, and local funding sources in accordance with generally ... management letter, and other applicable reports must be supplied to the Finance Director (or audit ...

https://www.nctreasurer.com/slg/Audit%20Forms%20and%20Resources/RFP_2013.doc

Date added: August 9, 2013 - Views: 22

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Example of a Request for Proposal Template for Maintenance ...

This sample Request for Proposals ... Certificate of Good Standing (Corporation) or Certificate of Existence ... of experience and detailed qualifications in performing the range of maintenance services on various property types in compliance with NESHAP standards, ...

https://www.onecpd.info/resources/documents/SampleRFPforMaintenanceContractors.doc

Date added: January 18, 2013 - Views: 134

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SAMPLE POLICY: - Seattle

HUD compliance guidelines define assistive animals as “animals that serve as a reasonable accommodation for persons with disabilities by assisting those individuals ... This is a sample letter for use when supporting a request for a service ... Canine Good Citizen Certificate ...

http://www.seattle.gov/civilrights/documents/Service%20Animal%20Policy%202007.doc

Date added: October 24, 2011 - Views: 33

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Sample Letter Employers Can Give to Employees

Sample Letter Employers Can Give to Employees ...

http://www.ssa.gov/employer/sampleltr.doc

Date added: September 13, 2011 - Views: 645

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Mortgagee Letter 2009-16 - HUD /U.S.

... attesting to compliance with the current guidelines. ... Acceptable Elevation Certificate ... Figure F.1 Sample Maximum Insurable Mortgage Determination for CP Manufactured Housing. 1. Mortgage Amount based on Total Cost or Itemized Value. a.

http://hud.gov/offices/adm/hudclips/letters/mortgagee/files/09-16ml.doc

Date added: October 20, 2011 - Views: 36

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[LETTERHEAD] - Alcohol and Tobacco Tax and Trade Bureau

We request a waiver from the Certificate of Label ... Each individual container shall bear a label stating “Sample Only – Not for Sale” or ... We also attest that the products indicated in this letter will be in compliance with the above requirements prior to the product ...

http://www.ttb.gov/itd/cola_waiverrequest__template.doc

Date added: September 13, 2011 - Views: 41

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SAMPLE

SAMPLE. MUST BE TYPED ON. BANK ... This Letter of Credit is established for the purpose of guaranteeing compliance with the regulations of the Virginia Department of Health in connection with an Alternative ... and presented for payment accompanied by a certificate signed by the Director of ...

http://www.fauquiercounty.gov/forms/departments/commdev/mswordfile/letterofcredit-AOSS.doc

Date added: May 5, 2013 - Views: 5

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SACS Compliance Certification - Commission on Colleges

... certificate, or diploma can be ... ___ Compliance The institution meets the requirement and provides a convincing argument in support of its ... and written institutional management letter for the most recent fiscal year prepared by an independent certified public accountant and/or an ...

http://www.sacscoc.org/forms/principle/Compliance%20Certification.doc

Date added: October 8, 2011 - Views: 17

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ATTACHMENT 1 - SAMPLE WARNING LETTER (UNDERGROUND STORAGE ...

This letter addresses conditions at the facility named above, ... State Water Control Law, any State Water Control Board rule or regulation, an order, permit condition, standard, or any certificate requirement or provision. ... SAMPLE WARNING LETTER (UNDERGROUND STORAGE TANK COMPLIANCE)

http://www.deq.virginia.gov/Portals/0/DEQ/Enforcement/Manual/Chapter2/attachments/2-2A-ModelWarningLetterUST.docx

Date added: August 23, 2013 - Views: 2

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CHAPTER 16 – AUDIT & CLOSEOUT - neded.org

The Final Wage Compliance Report, if applicable (grantee must submit within 3 months of the project’s last drawdown projects requiring adherence to labor standards, ... this letter constitutes a certificate of satisfactory completion of project requirements.

http://www.neded.org/files/crd/home_forms/home_manual/Home%20Chapter%2016%20-%20Audit%20&%20Closeout.doc

Date added: January 31, 2012 - Views: 27

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Records Destruction Certificate - Kentucky

The Records Destruction Certificate is a fielded Microsoft Word form that should be used by Records Officers to document destruction of records at an agency.

http://kdla.ky.gov/records/Documents/kyrecordsdestruction.DOC

Date added: September 1, 2011 - Views: 34

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Sample Letter Re: Hospital Privileges and Competency ...

... 1 = Element is present and in compliance, ... license PSV Board Certification Current DEA Certificate present Privileges Privilege form present and appropriate to specialty ... Sample Letter Re: Hospital ...

http://www.kathymatzka.com/Downloads/Chart_audit_form.doc

Date added: November 28, 2011 - Views: 16

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SAMPLE DISCHARGE LETTER - Campania

Title: SAMPLE DISCHARGE LETTER Author: Lori Frye Last modified by: Amy Johnston Created Date: 6/29/2007 4:03:00 PM Company: The Campania Group Other titles

http://www.thecampaniagroup.com/lossprevention/Tools/SAMPLE%20DISCHARGE%20LETTER.doc

Date added: November 3, 2011 - Views: 521

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Sample Safety Engineer Resume - ResumeLogic.com

Ensured compliance with Federal, ... Environmental Compliance Manager Certificate, Columbia Southern University, Orange Beach, ... Sample Safety Engineer Resume Author: Sample Safety Engineer Resume Last modified by: Paul Syiek Created Date:

http://www.resumelogic.com/sample_resumes/SampleResume-SafetyEngineer.doc

Date added: October 8, 2011 - Views: 231

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Awarding the Construction Contracts - University of Cincinnati

4 Sample Agenda for Project Orientation Meeting. 5 Bid Extension Letter. ... A valid Certificate of Compliance, issued by the Ohio Department of Insurance, ... The bid extension letter should also request the immediate return of any outstanding submittals.

http://www.uc.edu/architect/documents/procedures/internal/proguide/Awarding%20Construction%20Contracts.doc

Date added: October 14, 2011 - Views: 128

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PIECP ASSESSMENT TRAINING GUIDE - National Correctional ...

(See BJA Letter to Certificate Holder, Assessment Guide.) 2. ... If problems exist and Certificate Holder seeks compliance, assessor notifies NCIA. Assessor, BJA and NCIA formulate compliance plan. ... (See Sample Letter D,

http://www.nationalcia.org/wp-content/uploads/2013-PIECP-ASSESSMENT-GUIDE.docx

Date added: November 6, 2013 - Views: 1

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Finance Circular No 2013/03 Certificate of Compliance – FMA ...

Certificate of Compliance letter template. 19. 3.2. The Certificate of Compliance template. 20. 3.3. ... reporting ‘several,’ ‘a number of’ or ‘multiple’ instances of non compliance). The results of sample testing should not be extrapolated.

http://www.finance.gov.au/publications/finance-circulars/2013/docs/FC2013-03-Certificate-of-Compliance.doc

Date added: May 25, 2013 - Views: 2

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Operation and Maintenance Manual Certification of Completion ...

... Complete and submit this Certificate of Completion and include any attachments ... and specification approval letter for any additional specific ... ( NPDES/SDS permit special requirements such as bypass authorization, special provisions, compliance schedule, pretreatment ...

http://www.pca.state.mn.us/index.php/view-document.html?gid=8804

Date added: June 1, 2012 - Views: 47

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Finance Circular No 2013/03 Certificate of Compliance – FMA ...

Part 3.1 – Certificate of Compliance letter. Part 3.4 – Appendix B: financial sustainability schedule template. Foreword. Part 2.2 – Completing the Certificate. ... staff or undertake sample testing on compliance requirements? Surveying. a. gency.

http://www.finance.gov.au/sites/default/files/FC-2013-03.docx

Date added: April 29, 2014 - Views: 3