COMMONWEALTH OF PENNSYLVANIA 

STD-521 REV. 06-2010 INVOICE NO. 

PUBLICATIONS AUTHORIZATION AND INVOICE 

PUBLICATIONS AUTHORIZATION (To be completed by agency): 

1 FEDERAL I.D. NO.lSOC. SEC. NO. FROM: (NAME AND ADDRESS OF AGENCy) AGENCY j TELEPHONE NO. 

! I 

TO: (NAME AND ADDRESS OF NEWSPAPER) 

Harrisburg Patriot News 

2020 Technology Parkway 

Suite 300 

l....~.~=.~ .. ~?~~.?.~........................................................... Alex Haas i 717-787-9495 PA DEP - Bureau of Air Quality ....................................................................................... . 

Mechanicsburq, PA 17050 

HEREWITH IS ENCLOSED COPY FOR PUBLICATION OF ADVERTISEMENT FOR PROPOSALS TO 

o EMPLOY 0 PURCHASE 0 CONTRACT 0 SELL 

400 Market Street - 12th FI 

H;:Irri,hllrct PA 17101-?~01 

I 

TYPE OF ADD CLASSIFIED 

PUBLISH ADVERTISEMENT (NO. OF TIMES) I MAXIMUM NO. OF LINES DATE 

1 Time ONLY July 11, 2014 

I ORDER NO. 

IZl LEGAL NOTICE 

You, as vendor, are authorized to publish this advertiserhel]JAh you~newspaper, subjeQt tq the terms of this order, as follows: 

Advertisement to be published in regular advertising columns, no position specified; caption of two lines and signature to be in 

capitals and subject matter and title of officer to be set solid in type regularly used by your newspaper for public (legal) notice 

advertising; charge to be made at the rate charged to and paid by co'mmercial advertisers for matter similarly set and occupying 

similar space; advertisement to be run in the editions specified above. Vendor agrees that, in the performance of any contract 

awarded to it hereunder, said vendor will not discriminate against any employee or other persons on account of race, color, sex, 

religious creed, ancestry, age or national origin and that the Commonwealth, upon receipt of satisfactory evidence of such discrimination, shall have the right to cancel said contract. Return this copy at once if you will not accept this advertisement under 

the terms set forth. 

Return original and two copies (signed by the editor or publisher) to the agency listed above. Proof of advertising 

in the form of a tear sheet must be stapled to original and copies. Original must be notarized. 

Commonwealth to be billed only for actual number of printed lines published. " 

~APFUND COST CENTER GENERAL LEDGER ACCOUNT CODE % 

7027313000 3522710000 6343200 

I/O V16414000000 

INVOICE (To be completed by publisher): 

DATE OF INSERTION ACTUAL NO. OF PRINTED LINES COST PER LINE TOTAL AMOUNT 

I ;7 ", 

1stAd \ 

1/-'1~ 1/ ? I; / I. /\ I J 

" '., (,~/ " ( . I / "! 'r 

2nd Ad I 

, I( 

3rdAd I F 

GRAND I TOTAL 0+ { 

! 

Commonw Ith of Pennsylvania 

County of ~~~:CIIIIi:::~ 

Before me, the subscriber, a Notary Public in and for said ounty, pers 

Who~~~'pooe~ds~fu~he~*~.~~~~~~~~~~~~~ __ ~~~ ___ ~~ 

the Y::a.lL:tL1~ L a general newspaper publlshe at 

that the advertisement, of which tearsheet is attached hereto, was published in the regular advertising columns of said newsp 

in the editions of said newspaper, in all respects as ordered and invoiced above; and that the Commonwealth is not charg' 

therefor at a rate higher than is charged any ordinary advertiser for p s,imilar amount of matter occupying similar space and set ir 

similar matter, in said newspaper. 

*This affidavit must be made by the Owner, Publisher, or the designated agent of the owner or publisher. 

COMMONWEALTH OF PENNSYLVANIA 

Notarial Seal 

Donna M. Maldonado, Notary Public 

Susquehanna Twp., Dauphin County 

My Commission Expires Nov. 5, 2017 

MEMBER, PENNSYLVANIA ASSOCIATION OF NOTARIES 
S The Patriot-News Co. 

2020 Tbchnolo~y Pkwy 

Suite 300 

Mechanicsburg, PA 17050 

Inquiries - 717-255-8213 

Now you know 

DEPARTMENT OF ENVIRONMENTAL PROTECTION 

RACHEL CARSON STATE OFFICE BUILDING 

400 MARKET STREET 

HARRISBURG PA 17105 

THE PATRIOT NEWS 

THE SUNDAY PATRIOT NEWS 

Proof of Publication 

Under Act No. 587, Approved May 16, 1929 

Commonwealth of Pennsylvania, County of Dauphin} ss 

Marianne Miller, being duly sworn according to law, deposes and says: 

That she is a Staff Accountant of The Patriot News Co., a corporation organized and existing under the laws of the 

Commonwealth 9f Pennsylvania, with its principal office and place of business at 2020 Technology Pkwy, Suite 300, in the 

Township of Hampden, County of Cumberland, State of Pennsylvania, owner and publisher of The Patriot-News and The Sunday 

Patriot-News newspapers of general circulation, printed and published at 1900 Patriot Drive, in the City, County and State 

aforesaid; that The Patriot-News and The Sunday Patriot-News were established March 4th, 1854, and September 18th, 1949, 

respectively, and all have been continuously published ever since; 

That the printed notice or publication which is securely attached hereto is exactly as printed and published in their regular 

daily and/or Sunday/ Community Weekly editions which appeared on the date(s) indicated below. That neither she nor said 

Company is interested in the subject matter of said printed notice or advertising, and that all of the allegations of this statement as 

to the time, place and character of publication are true; and 

That she has personal knowledge of the facts aforesaid and is duly authorized and empowered to verify this statement on 

behalf of The Patriot-News Co. aforesaid by virtue and pursuant to a resolution unanimously passed and adopted severally by the 

stockholders and board of directors of the said Company and subsequently duly recorded in the office for the Recording of Deeds 

in and for said County of Dauphin in Miscellaneous Book "M", Volume 14, Page 317. 

PUBLICATION COpy ran on the dates shown below: 

July 17, 2014 

Sworn to and subscribed before me this 17 day of July, 2014 A.D. 

COMMONWEALTH OF PENNSYLVANIA 

Notarial Seal 

Donna M. Maldonado, Notary Public 

Susquehanna Twp., Dauphin County 

My Commission Expires Nov. 5, 2017 

ME~IBER, PENNSYLVANIA ASSOqAnON OF NOTARIES 
H~(r:sb,,~ 'Peo},:,,} Ne.~s 

P\Ah):sU J"')1 ) 7, ZO It..( 
The Patriot-News Co. 

2020 T~'chnolo9Y Pkwy 

Suite 300 

Mechanicsburg, PA 17050 

Inquiries - 717-255-8213 

DEPARTMENT OF ENVIRONMENTAL PROTECTION 

RACHEL CARSON STATE OFFICE BUILDING 

400 MARKET STREET 

HARRISBURG PA 17105 

STATEMENT 

AD ORDER # DATE EDITION ADDTL. INFO. 

233427 DEPARTMENT OF ENVIRONMENTAL 0002307259 07/17/14 REGULAR 

233427 DEPARTMENT OF ENVIRONMENTAL 0002307259 07/17/14 REGULAR 

Department of . . Env\rOnmental ProtectIon 

bt atri t - ttus 

Now you know 

ALL CHARGES ARE NET 

TYPE OF CHARGE AMOUNT 

BOLD TEXT CHARGE $4.00 

BASIC AD CHARGE $879.94 

AFFIDAVIT CHARGE $5.00 

JUl 2 4 701~ 

A'rRe5OUrce ~anage",ent Divis,on 

TOTAL: $888.94 

This is not an invoice. Please do not remit payment from this Statement. 

An invoice will be generated at the end of the month. --Thank you. 

NOTE: This Statement replaces the Order Confirmation which we previously sent with Proofs of Publication