1. The contact person's name; and

2. The contact person's job title; and

3. The contact person's e-mail address; and

4. The business's name; and

5. The business's address; and

6. The business's phone number or the contact person's phone number.

1. I, the undersigned, on behalf of the above named Company, approve, assert, and certify as true and accurate all information shown in this document. I hereby assert that the friction materials bearing the marked proof of certification set forth in this certification document are substantially identical to the products submitted for testing and meet the requirements of all applicable codes, regulations, rules, and laws including those specified in the addendum below. I hereby authorize [testing certification agency name] to publicly post all information required to be made public by any United States laws in accordance with the law and any written contracts between [testing certification agency name] and the Company specified above. I hereby assert that all test results used to issue this self-certification comply with all requirements of the law and any contracts between [testing certification agency name] and the Company specified above. Company agrees that [testing certification agency name] shall have no liability to Company or any third party with respect to release of the above referenced Company data to any government agency with the legal authority to receive such data. I hereby assert that I have the authority to make this authorization and assertion on behalf of the Company specified above. Any written modifications to this Affidavit section are not acceptable and invalidate this self-certification. This document shall serve as proof of self-certification as required by Health and Safety Code sections 25250.60 subdivision (c), subdivision (e), and subdivision (g).

1. For an electronic submittal, a person shall send the notification to the Department via electronic mail ([email protected]) on the Department's website at http://www.dtsc.ca.gov with the subject line “Attention: California Brake Pad Certification Notification” displayed in the subject line of the electronic mail; or

2. For a written submittal, a person shall send the notification to the Department via certified mail, return receipt requested, at the following address: Department of Toxic Substances Control, Safer Products and Workplaces Program, P.O. Box 806, Sacramento, CA 95812-0806, with the words “Attention: California Brake Pad Certification Notification” prominently displayed on the front of the envelope.