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Owner or Operator Certification <br />The person with overall administrative responsibility for SWPPP implementation must sign the annual report. This perso.: <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, including <br />the possibility of fine and imprisonment (Minn. R. 7001.0540). <br />X <br />Authorized Signature (This person must be duly authorized <br />to sign the annual report for the MS4) <br />Dircks Bill <br />Last Name First Name <br />515 Little Canada Road E <br />Date <br />Public Works Superintendent <br />Title <br />Mailing Address <br />Little Canada <br />City <br />651- 766 -4049 <br />Telephone (include area code) <br />MN 55117 <br />State ZIP code <br />bill.dircks @ci.little - canada.mn.us <br />E -mail Address <br />Submit your annual report by June 30, 2006 to: <br />MS4 Stormwater Program <br />Municipal Division <br />Minnesota Pollution Control Agency <br />520 Lafayette Road North <br />St. Paul, MN 55155 -4194 <br />If you have questions about the MS4 Annual Report for 2005 form, please visit the MPCA's MS4 Web site, <br />www.pca. state.mn.us/ water /stormwater /stormwater- ms4.html or call the MPCA's Keith Cherryholmes (651) 296 -6945 or <br />Scott Fox (651) 296 -9433. Contact the MPCA toll free at (800) 657 -3864. <br />wq- strm4 -06 <br />Page 6 jt 8 - 3/06 <br />