2013-05-08 CC Packet - Laserfiche WebLink

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Section 8: Additional SWPPP Issues ( * Required fields) A. *Did you make a change to any BMPs or measurable goals in your SWPPP since your last ❑ Yes U. No report? [Part V1. D.3.] B. If yes, briefly list the BMPs or any measurable goals using their unique SWPPP identification numbers that were modified in your SWPPP, and why they were modified: (Attach a separate sheet if necessary.) C. *Did you rely on any other entities (MS4s, consultants, or contractors) to implement any portion ❑ Yes El No of your SWPPP? [Part VI.D.4.] If yes, please identify them and list activities they assisted with: Owner or Operator Certification ( * Required fields) The person with overall administrative responsibility for SWPPP implementation and Permit compliance must certify this MS4 Annual Report. This person must be duly authorized and should be either a principal executive (i.e., Director of Public Works, City Administrator) or ranking elected official (i.e., Mayor, Township Supervisor). ❑ *Yes - I certify under penalty of law that this document and all attachments were prepared under my direction or supervision in accordance with a system designed to assure that qualified personnel properly gathered and evaluated the information submitted. Based on my inquiry of the person or persons who manage the system, or those persons directly responsible for gathering the information, the information submitted is, to the best of my knowledge and belief, true, accurate, and complete (Minn. R. 7001.0070). 1 am aware that there are significant penalties for submitting false information, including the possibility of fine and imprisonment (Minn. R. 7001.0540). *Name of certifying official: *Title: *Date: (mm /dd/yyyy) www.pca.state.mn.us • 651- 296 -6300 • 800. 657 -3864 TTY 651 - 282 -5332 or 800 - 657 -3864 • Available in alternative formats wq- strm4 -06 • 112312013 Page 5 of 5 6