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39. Sigoalnre of Applicant <br />"I certify under pematty oFlaw thm ibis document and ell atmchmems were prepared undermy direction m supervision in aaadaoce wids a system designed to assure that qualified <br />persomel properly gathered and evaluated the information submitted 13ased on my inquiry ofthe person m person who manage the system, or those person directly responsible <br />for gathe[ingthe irSormarian, the informarion submitted is W the best of my imowledge and belied true, accurate and complete. I am aware that there are signdicavt penalties for <br />submitting false inforrvptioq including inglpossibility offine and imprivonmera fm kmwmg violation." <br />signature ofOwna <br />Name <br />5 <br />~r~~ ~, ~J0~6 <br />Date signed <br />Thle ! /Ce5/ LI f i'1 / <br />~Jl -~!/~ <br />Date Signed l <br />Name (primed) <br />Tide p/E$r0 ~~ <br />30. Tn the case of facilities that intend ro discharge ro ditches or storm sewer, cernsission ro discharge roto sash systems must be obtained hrorrt the <br />owners or owners agents of each system mro which the pernsittee intends ro discharge. <br />•I cenifythat I Gave read and,•e~+~~+d the preceding paragraph and will comply with h by obtaining permission to discharge into the ditch or stormwaler systems tram the <br />owners m owners agems of each system imo which I imend to dis~arge". <br />Signature <br />Name (printed) <br />THE STATE OF TEXAS ) <br />COUNTY OF WICHITA ) <br />Date Signed <br />Title <br />t This instrument was acknowledged before me on October 25, 2006 by <br />Sandra Pautsky, President of Oakridge Energy, Inc. <br />NOTARY PUBLIC'S SEAL <br />~ ~~~~~~, <br />~""Y`~~ CAROL J COUP;.ii <br />NOTARY PU~3!.IC <br />' ~~y1 STATE OF 7E41S <br />"~~% M1~COMM. EXP.1/14(2010 <br />~ ~ <br />Notary Public f <br />the State of Texas <br />