This attestation form is to be used by a person who is a capped participant that receives petroleum products at the capped facilities in Ontario or persons who supply petroleum products to capped facilities of capped participants in Ontario.

Approved by Director (MOECC) for the purposes of section 5 (1) of O. Reg. 350/12.

This Notice only applies to a Non-Municipal Year-Round Residential System that has a raw water supply that is ground water, or that has been deemed, under paragraphs 4 or 5 of Section 2(12), section 2 of O. Reg. 170/03, to obtain water from a raw water supply that is ground water under the direct influence of surface water.