20070865 Ver 1_Certification of Completion_20120314

DWQ Project No
Applicant
Project Name
Certificate of Completion
City of Greensboro
Isaacson Boulevard Extension
County
Date of Issuance of 401 Water Quality Certification July 6 2007
Guilford
I
Upon completion of all work approved within the 401 Water Quality Certification and Buffer Rules and any
subsequent modifications the applicant is required to return this certificate to the Winston Salem Regional
Office North Carolina Division of Water Quality, 585 Waughtown Street Winston Salem NC 27107 This
form may be returned to DIN Q by the applicant the applicant s authorized agent, or the project engineer It
15 not necessary to send certificates from all of these
Applicant's Certification
Theodore H Partrick P E
hereby state that to the best of my abilities due care and
diligence was used in the observation of the construction such that the construction was observed to be built
within substantial compliance and intent of the 401 Water Quality Certification and Buffer Rules the
approved plans and specifications, and other supporting materials
Signature IA- lV L Date s m
Agent's Certification
I, hereby state that, to the best of my abilities due care and
diligence was used in the observation of the construction such that the construction was observed to be built
ithin substantial compliance and intent of the 401 Water Quality Certification and Buffer Rules the
approved plans and specifications and other supporting materials
Signature Date a @�an/j(�
V L5 D
ARY4zo�2
If this project was designed by a Certified Professional M °'►vs ReWATER Q(A,ITy
I as a duly registered Professional e
Engineer, Landscape Architect, Surveyor etc ) in the State of North Carolina having been authorized to
observe (periodically, weekly full time) the construction of the project for the Permittee hereby state that
to the best of my abilities due care and diligence was used in the observation of the construction such that
the construction was observed to be built within substantial compliance and intent of the 401 Water Quality
Certification and Buffer Rules, the approved plans and specifications and other supporting materials
Signature Registration No Date

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