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Okaloosa County BOCC — September 16, 2014 — 2014-2015 Hazards Analysis Agreement — reading text
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____________________________________________________________________________
CERTIFICATION:
I understand the requirements of the law(s) circled above. I also understand that ultimate compliance
responsibility lies with me and failure to comply, if required, can result in civil and criminal penalties under federal
and state laws.
Name of owner / operator’s authorized representative (printed):
Official Title (printed):
Signature: Date signed:
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