Circle K - SCM Certification - 2707 N. William St

WITH THE CITY OF GOLDSBORO STORMWATER MANAGEMENT
PROGRAM
(Use one certificate for each BMP in the project)
PROJECT NAME:
PROJECT ADDRESS:
IDENTIFICATION OF INDIVIDUAL BMP:
STORMWATER PERMIT NUMBER(IF ASSIGNED):
I hereby certify that I, or a person under my direct supervision, inspected the BMP described
above at the project site listed, and, to the best of my knowledge and information, the BMP has
been constructed in accordance with the plans and specifications approved by the City of
Goldsboro Department of Engineering unless noted below. I further certify that the BMP, as
constructed, will operate and function as designed by me and as presented to and approved by
the City of Goldsboro Department of Engineering, in accordance with the City of Goldsboro
Stormwater Management Program.
Deviations from Plans and Specifications for the BMP identified above (if none so state):
Daniel Perry
Signature of North Carolina Professional Engineer� Nov 10 2020 2:39 PM
Typed Name of North Carolina Professional Engineer:
North Carolina Registration Number:
Date of Certification:
A77p�f'•,
�O
(SEAL) 425 '
Daniel Perry
Certificate of Completion and Comp l aloe 10 2020 2:39 PM
7/15/2004
Neuse,Tar-Pamlico,and Falls Nutrient Load Reporting Form. September 12,2012