Written Authorization Form RCSA Section 22a-174-2a(a)(2)(B)
The above written authorization submittal naming an individual or position as a duly authorized representative for the purposes of compliance with RCSA section 22a-174-2a(a)(2)(B) has been: Approved Rejected Commissioner or Commissioner's Designee. Date Copy of Approval/Rejection Sent to Title V Source: Date Bureau of Air Management ................
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