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www.pca.state.mn.us • 651-296-6300 • 800-657-3864 • TTY 651-282-5332 or 800-657-3864 • Available in alternative formats <br />wq-strm4-49a • 5/31/13 Page 2 of 18 <br />Certification (All fields are required) <br /> Yes - I certify under penalty of law that this document and all attachments were prepared under my direction or supervision <br />in accordance with a system designed to assure that qualified personnel properly gathered and evaluated the information <br />submitted. <br /> I certify that 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. <br />I am aware that there are significant penalties for submitting false information, including the possibility of civil and criminal <br />penalties. <br />This certification is required by Minn. Stat. §§ 7001.0070 and 7001.0540. The authorized person with overall, MS4 legal <br />responsibility must certify the application (principal executive officer or a ranking elected official). <br />By typing my name in the following box, I certify the above statements to be true and correct, to the best of my knowledge, <br />and that this information can be used for the purpose of processing my application. <br />Name: Jay Hartman <br /> (This document has been electronically signed) <br />Title: Director of Public Works Date (mm/dd/yyyy): 12/30/2013 <br />Mailing address: 3301 Silver Lake Rd. <br />City: City of St. Anthony State: MN Zip code: 55418 <br />Phone (including area code): 612-782-3301 E-mail: jay.hartman@ci.saint-anthony.mn.us <br /> <br /> <br /> Note: The application will not be <br />processed without certification.