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D. Provide the following information of the individual responsible for conducting the review of <br />discharges to impaired waters and any associated BMP modifications: <br />Name: Bill Dircks <br />Title: Public Works Superintendent <br />Phone: 651-766-4049 <br />Email: bill .dircks@ci.little- canada.mn.us <br />E. Did you make a change to any identified BMPs or measurable goals that were submitted with your ❑ Yes ® No <br />permit application? [Part V.G.6.b.1] If yes, explain: <br />F. Briefly list the BMPs using their unique identification numbers you used in your SWPPP or any measurable goals that <br />will be changed in your updated SWPPP, and why they have changed: (Attach a separate sheet if necessary) <br />G. Did you rely on any other entities (MS4s, consultants or contractors) to satisfy any portion of your ® Yes ❑ No <br />SWPPP? If yes, please identify below the entity and for what activities: We relied on the Ramsey <br />Washington Metro Watershed District to help us with the education part of our SWPPP as well as <br />plan review and permitting for construction projects. <br />Owner or Operator Certification <br />The person with overall administrative responsibility for SWPPP implementation must sign the annual report. This person <br />must be duly authorized and should be the person who signed the MS4 permit application or a successor. <br />I certify under penalty of law that this document and all attachments were prepared under my direction or supervision in <br />accordance with a system designed to assure that qualified personnel properly gathered and evaluated the information <br />submitted. Based on my inquiry of the person or persons who manage the system, or those persons directly responsible <br />for gathering the information, the information submitted is, to the best of my knowledge and belief, true, accurate, and <br />complete (Minn. R. 7001.0070). I am aware that there are significant penalties for submitting false information, includin <br />the possibility of fine and imprisonment (Minn. R. 7001.0540). <br />X <br />Authorized Signature (This person must be duly authorized Date <br />to sign the annual report for the MS4) <br />Dircks Bill Public Works Superintendent <br />Last Name First Name Title <br />515 Little Canada Rd. E <br />Mailing Address <br />Little Canada MN 55117 <br />City State ZIP code <br />651- 766 -4049 bill .dircks@ci.little- canada.mn.us <br />Telephone (include area code) E -mail Address <br />wq- strm4 -06 <br />-6- <br />Page 5 of 5 <br />3/06 <br />