_PERMIT FILE - M2013026

• Permit No: M2013026
• IBM Index Class Name: Permit File
• Doc Name: Other Applications
• Media Type: D
• Archive: No

Water Quality Control Division—Stormwater www.coloradowaterpermits.com
ii. Signature of Permit Legal Contact
The application must be signed to be considered complete. In all cases, it shall be signed as follows:
a. In the case of corporations, by a responsible corporate officer.The responsible corporate officer is responsible for
the overall operation of the facility from which the discharge described in the form originates;
b. In the case of partnership, by a general partner;
c. In the case of a sole proprietorship, by the proprietor;
d. In the case of a municipal,state, or other public facility, by either a principal executive officer or ranking elected
official. For purposes of this section, a principal executive officer has responsibility for the overall operation of the
facility from which the discharge originates.
"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 qualified personnel properly gather and evaluate the information submitted. Based on my inquiry of the
person or persons who manage the system, or those persons directly 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 significant penalties for submitting false
information, including the possibility of fine and imprisonment for knowing violations."
Applicant Signature(submission must include original ink signature) Date Signed
Name(printed Title
DO NOT INCLUDE PAYMENT—AN INVOICE WILL BE SENT AFTER THE PERMIT CERTIFICATION IS ISSUED.
Page 5 of 8 Revised 3/2011