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5/18/22, 1:54 PM Q83 Optional, describe the file(s) uploaded: MS4 Annual Report for 2021 Owner or Operator Certification 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). 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). ❑ Yes By typing my name in the following box, I certify the above statements to be true and correct, to the best of my knowledge, and that information can be used for the purpose of processing my MS4 Annual Report. Name: Title: Date: (mm/dd/yyyy) When you are ready to submit, you must click the'Submit' button at the bottom of this page. Provide the email(s) of the individual(s) you would like to receive the MS4 Annual Report for 2021 submittal confirmation email from the MPCA. After you click the Submit button below, please allow up to three business days to receive this email. Email (1) Email (2) Email (3) Print or save a copy of your completed MS4 Annual Report for 2021 for your records. The MPCA will email a formatted version of your MS4 Annual Report for 2021 in a confirmation email within three business days after you submit this form to the email(s) you provided above. You may print a copy of the MS4 Annual Report for 2021 for your records by pressing the 'Print' button at the bottom of the page. Additionally, it is possible to save a PDF copy of the MS4 Annual Report for 2021 if you are working on a computer with OneNote (a program often included in Microsoft Office packages). Detailed saving instructions are available at stormwater.pca.state.mn.us/index.php/Guidance for saving MS4 annual reports. If you have any questions, contact MPCA staff Cole Landgraf (cole.landgraf@state.mn.us, 651-757-2880). https://su wey.mn.gov/siam/su weylanding/printerviewer.asp?sid=37f44a97ae6948Ob9l fO7Oa11 a28c4e5 10/10