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5/17/2017 <br />MS4 Annual Repatfa 2016 <br />Owner or Operator Certification <br />The person with overall administrative responsibility for SWPPP implementation and <br />Permit compliance must certify this MS4 Annual Report. This person must be duly <br />authorized and should be either a principal executive (i.e., Director of Public Works, <br />City Administrator) or ranking elected official (i.e., Mayor, Township Supervisor). <br />I certify under penalty of law that this document and all attachments were prepared <br />under my direction or supervision in accordance with a system designed to assure that <br />qualified personnel properly gathered and evaluated the information submitted. Based <br />on my inquiry of the person or persons who manage the system, or those persons <br />directly responsible for gathering the information, the information submitted is, to the <br />best of my knowledge and belief, true, accurate, and complete (Minn. R. 7001.0070). 1 <br />am aware that there are significant penalties for submitting false information, including <br />the possibility of fine and imprisonment (Minn. R. 7001.0540). <br />E)Yes <br />By typing my name in the following box, I certify the above statements to be true and <br />correct, to the best of my knowledge, and that information can be used for the purpose <br />of processing my MS4 Annual Report. <br />Name: <br />Title: <br />Date: <br />(mm/dd/yM) <br />When you are ready to submit, you must click the <br />'Submit' button at the bottom of this page. <br />Provide the email(s) of the individual(s) you would like to receive the MS4 Annual <br />Report for 2016 submittal confirmation email from the MPCA. After you click the <br />Submit button below, please allow up to three business days to receive this email. <br />Email <br />(1) <br />Email <br />(2) <br />Email <br />(3) <br />https://survey.mn.gw/siam/surveylanding/printervie er.asp?sid=746D70736C72717632313439353035333931332E3038 14/15 <br />