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<br />information. <br /> <br />7. Does the MS4 have a process to evaluate discharges which may adversely affect IZIVes DNa <br />properties listed or eligible for listing in the National Register of Historic Places or <br />affecting known or discovered archeological sites? See Part IX of the Guidance Manual <br />for Small Municipal Separate Storm Sewer Systems (MS4s) for further information. <br /> <br />If you answered "No" to Item 5, 6, or 7, briefly explain how the MS4 will come into compliance with the <br />requirements of Appendix C. <br /> <br />'fl. I)Wnl~r or I) ~alrQr Oel"lrificatioo <br /> <br />The person with overall, site or administrative area SWPPP implementation responsibility must sign the <br />application. This person must be duly authorized to sign the application (mayor, designated public works <br />director, president of the university, etc.). <br /> <br />I certify under penalty of law that this document and all attachments were prepared under my direction or <br />supervision in accordance with a system designed to assure that qualified personnel properly gathered and <br />evaluated the information submitted. Based on my inquiry of the person or persons, who manage the system, or <br />those persons directly responsible for gathering the information, the information submitted is, to the best of my <br />. knowledge and belief, true, accurate, and complete (Minn. R. 7001.0070). . <br /> <br />I also certify under penalty ofIaw that I have read, understood, and accepted al~term . nditions of the <br />National Pollutant Discharge Elimination System (NPDES) General Storm Wa . for MS4s that <br />authorizes storm water discharges identified in this application form. ~ <br /> <br />I understand that as a permittee, I am legally accountable under.u(.~ater Act to ensure compliance with <br />the terms and conditions of the NPDES Gen~rm 0~~~t for MS4s. <br /> <br />I also understand that MPCA en!Jir,.,.c~~cti ~ant to Minn. Stat. {ll 15.07, 116.072, and Section 309 <br />of the Clean Water Act) m~.l(t~~;-;' t r the MS4 if the terms and conditions of the NPDES General <br />Storm Water Permit f~~~e not~ <br /> <br />S~ <v~~ <br /> <br />Authonzed SIgnature ~ V <br /> <br /> <br />Schwartz <br /> <br />Date <br /> <br />Duane <br /> <br />Public Works Director <br /> <br />Last Name First Name <br />Official notices will be sent to person indicated here. <br />2660 Civic Center Drive <br /> <br />Title <br /> <br />Mailing Address <br />Roseville <br /> <br />MN 55113 <br /> <br />City <br />651-490-2220 <br /> <br />State <br /> <br />Zip Code <br /> <br />Telephone (include area code) <br /> <br />duane.schwartz@ci.roseville.mn.us <br />E-Mail Address <br /> <br />MPCA MS4 Storm Water Pennit Application <br /> <br />60f8 <br /> <br />02/06103 <br />