FORM WSIA/PDC/S: WATER SERVICES INDUSTRY ACT 2006 WATER SERVICES INDUSTRY (PLANNING, DESIGN AND CONSTRUCTION OF SEWERAGE SYSTEM AND SEPTIC TANK) RULES 2013 DETAILS FOR EQUIPMENT AND MATERIAL DATA SHEETS (EMDS) Date: 20 To: Sewerage Certifying Agency | hereby declare in accordance with the Statulory Declaration Act 1960 that the installation and details in the equipment and material data sheet for the stated sewerage works: con addressfot(s) ‘are complete, irue and accurate. | hereby further declare that the mechanical works will be instal in accordance to sound engineering practice and In ‘accordance to the approved design, Malaysian Sewerage Industry Guidelines and Standards and that | take full responsibilty forthe installation and performance of the same. Signature of Competent Person Name of Competent Person {in block letters) LC. No. Address Telephone No FaxNo. E-mail adéress FOR OFFICIAL USE ONLY Reference No: