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Q77 <br />.� Minnesota Pollution <br />Control Agency <br />Partnerships <br />Q78 Did you rely on any other regulated MS4s to satisfy one or more Permit requiremems7 <br />res <br />Q79 <br />f'Yes' in Q78, describe the ailtreerrents you have with otherregulated MS4s and which Permit requirements the other mated Mc4s helpsatisfy <br />Rice Geek Watershed District <br />Minnesota Pollution <br />Control Agency <br />Additional Information <br />(Part W.B.&) <br />N you would like to provide any, additional fila to accomparry your annual report, use the space below to upload those files. for each spare, you may attach one file. You may <br />Provide additional eapfanation and/or information In an email with the subject YourMS41ilametlere 2016AR to msispermkpragram.pa@stm.mn.us. <br />QIID <br />Successfully uploaded file: <br />No fBe attached. <br />Q81 <br />Successfully uploaded file: I <br />Nolgeattoched. <br />Q82 <br />Successfully uploaded ilk: I <br />Nof0e atrashed. <br />Q03 <br />Minnesota Pollution <br />Control Agency <br />Owner of Operator Certification <br />The person with overall administrative responsibility for SWPPP implementation and Permit compliance must certify this MS4 Annual Report. This person must be duty <br />authorized and should be either a principal eaeartive (i.e., Director of Public Works, City Administrator) or ranking elected official (i.e., Mayor, Township supervisor). <br />I certify under penalty of law that this document and a0 attachments were prepared under my direction or supervision in accordance with a system <br />designed to assure that qudiRed personnel properly gathered and evaluated the Information submitted. Based on my Inquiry of the person or persons <br />who manage the system, or those persons directly responsible for gathering the information, the information submitted is, to the best at my knowleelige <br />and belid, true, accurate, and complete (Minn. R 700L0070). i am aware that there are significant penalties for submRtkig false Information, including <br />thepoasibliRy of fine and fmonm <br />prlserd (Minn. R. 7001.0540). <br />% Ya <br />By typing my name In the following box, I certify the above statements to be true and corned, to the best of my borAedge, and that <br />information can be used for the purpose of processing my MS4 Annual Report. <br />Name: <br />Mldnd A. Erkson <br />.: City Administrator <br />Date, 17/2017 <br />11 <br />