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8. Please include any ezisting quality data on stormwater discharges. <br />9. I certify under penalty of law that I have personally ezamined and am <br />familiar with the information submitted in this application and all <br />attachments and that, based on my inquiry of those individuals <br />immediately responsible for obtaining the information, I believe that <br />the information is true, accurate and complete. I am aware that there <br />are significant penalties for submitting false information, including <br />the possibility of fine or imprisonment. <br />1.) <br />A. SIGNATURE OF OWNER s B. DATE SIGNED <br />2.) <br />C. NAME (PRINTED) D. TITLE <br />A. SIGNATURE OF OPERATOR B. DATE SIGNED <br />C. NAME PRINTED D. TITLE <br />-5- <br />0036M/0488M <br />