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CERTIFICATION OF ADOPTION <br />WATER SUPPLY PLAN <br />City or Water System Name: <br />Name of Person Authorized to Sign <br />Certification on Behalf of the System: <br />Title: <br />Address: <br />Telephone: Fax: <br />E -mail: <br />I certify that the Water Supply Plan approved by the Department of Natural Resources <br />has been adopted by the city council or utility board that has authority over water supply <br />services. <br />Signed: <br />Date: <br />Fax (651/772 -7977) or mail this certification to: DNR Waters <br />1200 Warner Road <br />St. Paul, MN 55106 <br />Or, scan and email to: dale.homuth @state.mn.us <br />77 <br />