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DESIGNATION/CERTIFICATION OF ASPHALT -RUBBER BINDER APPLICATOR(S) <br />BIDDER proposes to have Asphalt -Rubber BINDER for ARAM (application) applied by: <br />Manhole Adjusting, Inc., 9500 Beverly Rd., Pico Rivera, CA 90660-2135 <br />Name/Address <br />This section shall be completed even if the bidder plans to apply Asphalt -Rubber binder <br />with its own equipment and labor forces. Name above must be the actual company <br />applying the Asphalt -Rubber binder on the roadway. <br />Bidder shall attach to this form copies of all required local air pollution control district or air <br />quality management district final permit to operate (PTO) documents (not temporary, <br />experimental, research, and/or authority to construct (ATC)) which allow the operation of <br />the specific equipment to be used to control emissions during the application of <br />Asphalt -Rubber binder on the roadway (the Application). The Application, in a manner <br />conforming with these project specifications, has been indisputably determined to be in <br />non-compliance with California air quality regulations limiting opacity of emissions, unless <br />a permitted emission control device is used during the Application to directly remove <br />emissions occurring during the Application. It is for that device, which may be described <br />as an air filter, custom air pollution control system, portable air pollution control, opacity <br />control unit, emission control unit consisting of collection hood and 3 -stage oil mist filter <br />system, or other similar description for which a copy of a final PTO must be provided <br />from the local air pollution control district or air quality management district. <br />If the bidder fails to fully complete this portion of the bid and provide the foregoing <br />documentation, the bid is non-responsive and shall be rejected. <br />CERTIFICATION UNDER PENALTY OF PERJURY <br />I certify under penalty of perjury under the laws of the State of California that I <br />have read and understand the requirements contained in this form. I further certify <br />that all information provided in response to this form is true and accurate to the <br />best of my knowledge and belief. <br />Print Name, Title <br />,L/ HU 1, r 2015 <br />of Bidder Date <br />912011 <br />