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2009-08-28_PERMIT FILE - M2009035 (3)
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2009-08-28_PERMIT FILE - M2009035 (3)
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Last modified
8/24/2016 3:55:06 PM
Creation date
9/18/2009 7:47:09 AM
Metadata
Fields
Template:
DRMS Permit Index
Permit No
M2009035
IBM Index Class Name
PERMIT FILE
Doc Date
8/28/2009
Doc Name
112c application w/amendment
From
MA Concrete Construction, Inc.
To
DRMS
Email Name
THM
Media Type
D
Archive
No
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18. STORMWATER MANAGEMENT PLAN <br />This item applies to all facilities. A Stormwater Management Plan (SWMP) shall be prepared prior to applying for coverage under the general permit, <br />and the following certification signed. See the SWMP requirements in Appendix B. <br />• "I certify under penalty of law that a complete Stormwater Management Plan, in compliance with Appendix B of this application, has been <br />prepared for my facility. Based on my inquiry of the person or persons who manage the system, or those persons directly responsible for <br />gathering the information, the SWMP is, to the best of my knowledge and belief, true, accurate, and complete. I am aware that there are significant <br />penalties for falsely certifyingthe completion of said SWMP, including the possibility of fine and imprisonment." <br />/ lI°) nim-1, ?.?el,Nti'V? ` --- 1 `Z • `I-- 0 ? <br />Signature of Permit Applicant' Date Signed <br />MAZ:r/N AZZ-4arA46 OWNEZ- / i!;,?EXA TJ2 <br />Name (printed) <br />19. Signature of Applicant <br />Title <br />"I certify under penalty of law that 1 have personally examined and am familiar with the information submitted in this application and all <br />attachments and that, based on my inquiry of those individuals immediately responsible for obtaining the information, I believe that the <br />information is true, accurate and complete. I am aware that there are significant penalties for submitting false information, including the <br />possibility of fine and imprisonment." n <br />Signature of Owner Date Signed <br />F;IZ/Awj WoonS MANA4-rm- <br />• <br />Name <br />Title <br />Signature of Operator Date Signed <br />44AP-7 -i,y A Ze-Ar- ,9.4 OwNEe- oPEr-A"M 2- -- <br />Name (printed) <br />Title <br />is
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