Form ID

Publication date

Location of premises

Certificate

Date substantially performed:
Date certificate signed:

Participants

Name of Owner
Oxford County
Address of Owner
21 Reeve Street, P.O. Box 1614, Woodstock, ON N4S 7Y3
Name of Contractor
Terratec Environmental A division of Revolution Environmental Solutions LP
Address of Contractor
200 Eastport Blvd, Hamilton, ON L8H 7S4
Name of Certifier
Don Ford, Wastewater Supervisor Oxford County Public Works
Address of Certifier
Same as Owner

Office to which claim for lien must be given to preserve lien

as above