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Get PA FP-001 2010-2024

Ss: The quantity of clean fill to be placed on the property is: <3,000 cubic yards 3,000 cubic yards to 20,000 cubic yards >20,000 cubic yards I, the undersigned, certify under penalty of law (18 Pa. C.S.A. §4904) that the information provided is true and correct to the best of my knowledge, information and belief. Signature: * * * * * Prior to placement of the clean fill, the owner of the property receiving fill material shall provide a copy of this completed form and attachments to the D.

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