Intertractor America Corporation - Executive Summary

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RMP*Submit User Manual February 1999 Appendix C C-1 
APPENDIX C 
SAMPLE CERTIFICATION LETTERS 
Certification Statement for Program 1 Process(es): 
Based on the criteria in 40 CFR 68.10, the distance to the specified endpoint for the worst-case 
accidental release scenario for the following process(es) is less than the distance to the nearest public 
receptor: 
C [insert description for first program 1 process from executive summary] 
C [insert description for second program 1 process from executive summary]] 
C etc. 
Within the past five years, the process(es) has (have) had no accidental release that caused offsite 
impacts provided in the risk management program rule (40 CFR 68.10(b)(1)). No additional measures 
are necessary to prevent offsite impacts from accidental releases. In the event of fire, explosion, or a 
release of a regulated substance from the process(es), entry within the distance to the specified endpoints 
may pose a danger to public emergency responders. Therefore, public emergen 
cy responders should not 
enter this area except as arranged with the emergency contact indicated in the RMP. The undersigned 
certifies that, to the best of my knowledge, information, and belief, formed after reasonable inquiry, the 
information submitted is true, accurate, and complete. 
_________________________________ _________________________________ 
Signature Print Name 
_________________________________ _____________ 
Title Date 
Certification Statement for Program Level 2 & 3 Processes: 
To the best of the undersigned's knowledge, information, and belief formed after reasonable inquiry, the 
information submitted is true, accurate, and complete. 
_________________________________ _________________________________ 
Signature Print Name 
________________________________ _____________ 
Title Date
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