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Owner or E o erator Certitleatiu <br />The person with overall administrative responsibility for S WPPP implementation must sign the annual report. This person most be duly <br />authorized and should be the person who signed the N1S4 permit application or a successor. <br />I certify under penalty of law that this document and all attachments were prepared under my <br />direction or supervision in accordance with a system designed to assure that qualified personnel <br />properly gathered and evaluated the information submitted. Based on my inquiry of the person <br />or persons who manage the system, or those persons directly responsible for gathering the <br />information, the information submitted is, to the best of my knowledge and belief, true, accurate, <br />and complete (Minn. R. 7001.0070). I am aware that there are significant penalties for <br />submitting false information, including the possibility of fine and imprisonment (Minn. R. <br />7001.0540). <br />3/10/05 <br />Authorized Signature (This person must be duly authorized to sign the annual report for the MS4) Date <br />Elfering <br />Lee City Engineer <br />Last Name First Name <br />515 Little Canada Road East <br />Tine <br />Mailing Address <br />Little Canada <br />MN 55117 <br />City State Zip code <br />(763) 434 -5720 Elfering@elferingassociates.com <br />Telephone (include area code) E-Mail Address <br />Please submit your annual report by March 10, 2005 to: <br />MS4 Stormwater Program <br />Municipal Division <br />Minnesota Pollution Control Agency <br />520 Lafayette Road North <br />St. Paul, Minnesota 55155 -4194 <br />7 <br />2/18/2005 <br />- 1 0 - <br />