As the applicant, I certify and represent, under the penalty of law, the information provided herein, and all accompanying documentation supplied with this application, is true, correct and authentic. I understand and acknowledge that submitting false information or fraudulent statements or writings in a matter under the jurisdiction of a state agency is a crime and can result in fines, imprisonment or both (O.C.G.A 16-10-20).
Further, I agree to abide by the rules and regulations set forth by the Environmental Protection Division of the Georgia Department of Natural Resources. I understand any reports of violation of the emission inspection law, or of the rules and regulations will be investigated, and, if found to be true, could result in my decertification as an emission inspector or other penalties. It is my responsibility to notify GCAF of any change in home address. Failure to keep my address current is a program violation and could result in my license being suspended or revoked. In addition, it is my responsibility to notify GCAF within five days (written form) of changing employment in order to have my inspector number removed from the former employer's GAS unit.
By entering my name in the field below, I certify that I am the person that is the subject of this application, and I fully authorize the Georgia Environmental Protection Division (EPD) and Opus Inspection Technologies, Inc. to accept it as the equivalent signature for any and all purposes, including civil and criminal enforcement actions.
Applicant or Registered Owner Signature (Electronic Signature)
