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39. Signature of Applicant <br />"I certify under penalty of law that this document and all attachments were prepared under my direction or supervision in accordance with a system designed to assure that <br />qualified personnel properly gathered and evaluated the information submitted. Based on my inquiry of the person or persons who manage the system, or those persons direct!: <br />responsible for gathering the information, the information submitted is to the best of my knowledge and belief, true, accurate and complete. I am aware that there are significat <br />• penalties for submitting false information, including the possibility of fine and imprisonment for knowing violations." <br />Signature of Owner Date Signed <br />Name (printed) Title <br />Signature of Operator Date Signed <br />Name (printed) Title <br />40. In the case of facilities that intend to discharge to ditches or storm sewers, permission to discharge into such systems must be obtained from the <br />owners or owners agents of each system into which the permittee intends to discharge. <br />"I certify that I have read and understand the preceding paragraph and will comply with it by obtaining permission to discharge into the ditch or stormwater systems from the <br />owners or owners agents of each system into which I intend to discharge ". <br />Signature Date Signed <br />• Name (printed) Title <br />• <br />14 <br />