HomeMy WebLinkAboutWPO201700043 Approval - County WPO VSMP 2017-07-11 Section 9 - Signed Certification
CERTIFICATION
"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 gather and evaluate 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. I am
aware that there are significant penalties for submitting false information, including the possibility of
fine and imprisonment for knowing violations."
Operator Name: PriHo ti
Company: /Me/ -1;) C
Title: U/'
Signature: �—�
Date: --7/7///
Section 10 - Delegation of Authority
Delegation of Authority
I M4R U/1i4 r (name), hereby designate the person or specifically described position
below to be a duly authorized representative for the purpose of overseeing compliance with
envir nmental requirements, including the Construction General Permit, at the
)ci..seT &veikoA j of vgs, construction site. The designee is authorized to sign any
reports, stormwater pollution 'prevention plans and all other documents required by the permit.
(2)1 fro - (name of person or position)
/-7v
w � (company)
com any)
1198S—
-r �.
1 8S'Sit,41 o,c 'fret 1 (address)
CAA.//fieS` ,1Jr 17- '2-9O/ (city, state,zip)
113L/ 1-7/i (phone)
By signing this authorization, I confirm that I meet the requirements to make such a designation as set
forth in the Construction General Permit(CGP), and that the designee above meets the definition of a
"duly authorized representative".
Operator Name: P74n
)1941y S
Company: /We J is
Title: 1i P
Signature:
Date: -7/1✓/1 7