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5. The name of the receiving waters(s). (If discharge is to a ditch or storm sewer, also include the name of the ultimate <br />receiving water): <br />CUW CREE?k B jet k/LC. G ((L G,l M&1 - 66-77 <br />6. Describe the industrial activities which take place on site. <br />'AFL. <br /> <br /> <br />7. Stormwater Management Plan Certification: A Stormwater Management Plan (SWMP) shall be prepared prior to <br />applying for coverage under a general permit, and the following certification signed. See SWMP requirements in <br />Appendix B. <br />"I certify under penalty of law that a complete Stonmwater Management Plan (SWMP), in compliance with Appendix B of <br />the application, has been prepared for my facility. The SWMP was prepared under my direction or supervision and with a <br />system designed to assure that qualified personnel properly,gather and evaluate the information submitted. Based on my <br />inquiry of the person or persons who manage the system, or those persons directly responsible for gathering the <br />information, the S WMP is, to the best of my knowledge, V f, true, accurate, and complete. I am aware that there are <br />significant penalties for submitting false informati gg ,? ossibility of fine and imprisonment. <br />MES-t--?F 3 as ?o <br />?Z4 <br />Signature of Clegall.VResponsible Person (su issp qWj*( frig signature) Date Signed <br />Name (printed) SSl1iAL Title <br />8. Signature of Applicant <br />"I certify under penalty of law that I have personally examined and am familiar with the information submitted in this <br />application and all attachments and that, based on my inquiry of those individuals immediately responsible for obtaining <br />the information, I believe that the information is true, accurate and complete. I am aware that there are significant <br />penalties for submitting false information, including the possibil' f fine or imprisonment. <br />P, ? ?' ?A oyQ aoaL.cF? <br />Si tune o y Responsible Person (submissio U. ude on 13i ature) Date Signed <br />421-89 m= VICE P?'0? <br />RC - <br />S •' t4Q <br />Name (printed) Title <br />???. ••,? N.•'?Q. <br />ss??NAL ENG` <br />3/07/MM 2 of 2