NCC202736_NOI Signed Certification_20200630

IN,CCO! Notice Of intent (N,01) Certification Form
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Do NOT MAIL TwS FORM OR PAYMENT U14TIL YOUR APPUr-ATION HAS BEEN
Rmt Wt Q AND AC EPUD AS COMPLETE
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air fAA Aff W or a rkde 6111PNOWN" tM Artk.Ar - .. $#ON aw VwWy of o Clas t ftsdennechnOr which may
fatdV **W rA t to rangy wo obousorrd adbrs (SiQOWI
L%N4 r penrf[y al Ww, I CWt*r tt+si lc 02 boon to WdWSts VOW agrerrrnrnt)
I wn ttw rqspordibie for ft comtrtreWO W* RKs of this Dr'O00. for trtisf)pn6 the
its of thus peroWL and for "C*d Or erlm.nN Rena tie; incurred due to 0OLItlmrn Of ttxs
The trr wimatron subv0TWd hm thrls Wl rs, to the best of arty k'*VmkK Be and beW. true, accurate- and
cionwirte based on rrrt ww3v1ry of the person or persons wtio "wwW the systM or those pefu>rm
dvtcth respond* for Rathenrq the Ynforrrtiat•tir►
I wra abide by all conditions of the d f C 14Y? ^�rlMi rmas AM, the approved fr000n ar+d
ter/ 'Sedrrsent COrrtr�of Ptin-
MI ff the app"Ned IMSion arrd Sail t COntrOl Plan is not compUrlt vVVIh flit 1I IStrtMwater PolluM +
Prxvrrtron Man) of the MCC;Q1l7 M raI_R_=f I I Will I ionetheless emwe that al Coadiklloi%of
Part 11 of ttw perwA are met on the prchfect at 611 tunes
I heretlir request coverap under the KWIM (itntrall RlEEN and understand that C*Verate
tfrs permit w+ll constitute the ptmid rtqu retnents for the dischargeis) and is enkorcerabie in tt*
same manner as an lrxWdaal pe mil-
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the Pertitllt:
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•P^rint karat and Title of LgJedf
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I+r P0ffrAJvr Alt TE- Mis farm must be xApritte by a rrspornt bk Corpoote 4W thor owns or
carhstrwhm dc?rr'ry; UKlh as Q piwrdeal. scut fry, tr, reer, or tricar prtsa* ti, or o monoger that is
%rthorrred us oacvrdance IRYM Pan IV, Sector 8, item (6) of the itilE'W10WO ptrnitt.
,�W mean rraf forn"at, on siipw(ory requkrmmts, Sa!+t Pan IV, Scctm 8, It m (6) of d* HCGOI OWO permit.