Laserfiche WebLink
1 ' � � <br /> 1 � ] <br /> Part V. Certification <br /> I certify under penalty of law that this document and all attachments were prepared under my direction <br /> or supervision in accordance with a system designed to assure that quali�ed personnel properly gather <br /> and evaluate the information submitted. Based on my inquiry of the person or persons who manage the <br /> system, or those persons directly responsible for gathering the information, the information submitted is, <br /> to the best of my knowledge and belief, true, accurate, and complete. I am aware that there are <br /> significant penalties for knowingly submitting false information, including the possibility of fine and <br /> imprisonment. <br /> Authorized Representative Name and Title Signature Date <br /> Stephen P. Swanson, P.E. <br /> Director of Engineering and <br /> Infrastructure <br /> Mail completed form to: ILLINOIS ENVIRONMENTAL PROTECTION AGENCY <br /> DIVISION OF WATER POLLUTION CONTROL <br /> ATTN: PERMIT SECTION <br /> POST OFFICE BOX 19276 ' <br /> SPRINGFIELD, ILLINOIS 62794-9276 I <br /> Information required by this form must be provided to comply with 415 ILCS 5/39(2000). Failure to do so may prevent this form from being processed and could <br /> result in your application being denied. <br /> Page 5 <br />