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COG500000 Permit Application www.coloradowaterpermits.com <br />Page 8 of 8 – Revision 2/2021 <br />K.STORMWATER MANAGEMENT PLAN (SWMP) CERTIFICATION - required ONLY for applications requesting <br />stormwater-only outfalls. <br />The Stormwater Management Plan must be completed prior to signing the following certifications! <br />A Stormwater Management Plan (SWMP) shall be prepared prior to applying for stormwater coverage under the <br />general permit, and the following certification signed. <br />“I certify under penalty of law that a complete Stormwater Management Plan has been prepared for my activity. Based <br />on my inquiry of the person or persons who manage the system, or those persons directly responsible for gathering the <br />information, the Stormwater Management Plan is, to the best of my knowledge and belief, true, accurate, and <br />complete. I am aware that there are significant penalties for falsely certifying the completion of said SWMP, including <br />the possibility of fine and imprisonment for knowing violations.” <br />Signature of Legally Responsible Person or Authorized Agent Date Signed <br />Name (printed) Title <br />L.REQUIRED CERTIFICATION SIGNATURE [REG 61.4(1)(H)] <br />"I certify under penalty of law that this document and all attachments were prepared under my direction or supervision <br />in accordance with a system designed to assure that qualified personnel properly gather and evaluate the information <br />submitted. Based on my inquiry of the person or persons who manage the system, or those persons directly responsible <br />for gathering the information, the information submitted is to the best of my knowledge and belief, true, accurate and <br />complete. I am aware that there are significant penalties for submitting false information, including the possibility of <br />fine and imprisonment for knowing violations." <br />Signature of Legally Responsible Person or Authorized Agent Date Signed <br />Name (printed) Title <br />This form must be signed by the permittee to be considered complete. Per Regulation 61, in all cases, it shall be <br />signed as follows: <br />a)In the case of corporations, by a responsible corporate officer. For the purposes of this section, the responsible <br />corporate officer is responsible for the overall operation of the facility from which the discharge described in the <br />application originates. <br />b)In the case of a partnership, by a general partner. <br />c)In the case of a sole proprietorship, by the proprietor. <br />d)In the case of a municipal, state, or other public facility, by either a principal executive officer or ranking elected <br />official. <br />DO NOT INCLUDE A COPY OF THE STORMWATER MANAGEMENT PLAN with the application <br />DO NOT INCLUDE PAYMENT – AN INVOICE WILL BE SENT AFTER THE CERTIFICATION IS ISSUED. <br />Robert Haun <br />Robert Haun VP of Operations <br />11/18/2024Robert Haun <br />Digitally signed by Robert Haun <br />DN: cn=Robert Haun gn=Robert Haun c=US United States l=US United States <br />o=Raptor Materials LLC ou=Con/Agg e=rhaun@raptormaterialsllc.com <br />Reason: I am the author of this document <br />Location: <br />Date: 2024-11-18 15:32-07:00