Pinal County, AZ · Pinal County
Annual Certification Form
Permit holders use this annual form to certify compliance with permit terms and conditions and identify the facility and responsible official.
At a glance
- Issued by
- City of Pinal County · Pinal County, Pinal County, Arizona
- Notarization
- Not required: file this form without a notary.
- Official source
- pinal.gov
- Blank form
- Download the PDF
- Catalogued
- Machine-readable
- JSON record · about the forms index
What this form is
This form is for a permittee to submit an annual certification of compliance with the provisions of a permit. It asks the responsible official to identify the permit terms or conditions covered, verify compliance status and whether compliance has been continuous or intermittent, and identify the basis for the certification. If any condition or term is not met, the form calls for a separate report describing non-compliance and remediation.
Who needs it
A permittee required by their permit to submit an annual compliance certification should complete this form through a responsible official.
How to submit it
Submit it to the county department named on the form; check the county website for current contact details.
About notarization
This document is signed without a notary; the responsible official signs and dates it, and any separate non-compliance report is attached.
How to submit this form
- 1
Download the Form
Download the Annual Certification Form PDF.
- 2
Complete the Certification
Identify the permit terms or conditions covered, verify compliance status and whether compliance was continuous or intermittent, and identify the basis for the certification.
- 3
Gather Any Attachment
If any permit term or condition is not met, prepare a separate report with the required non-compliance details and attach it.
- 4
Sign and Date
Have a responsible official print their name and title, then sign and date the form.
- 5
Submit to the County
Submit it to the county department named on the form; check the county website for current contact details.
Frequently asked questions
- Do I need a notary for the Annual Certification Form?
- No. The responsible official signs and dates this form without a notary. If there is non-compliance, attach a separate report describing it; the document does not say that report must be notarized.
- How do I submit the Annual Certification Form?
- The form does not give a submission address or method. Submit it to the county department named on the form, and check the county website for current contact details.
- What information does the Annual Certification Form request?
- It asks for the company and facility names, the responsible official's printed name, title, signature, and date, plus certification details about permit terms and compliance.
- What if the facility is not in compliance with a permit condition?
- The form says to attach a separate report specifying the areas and reasons for non-compliance, actions taken to remediate the problems, and the expected date the facility will become compliant.