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Certification (All fields are required) <br />® Yes - 1 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 />1 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 />1 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: Scott Anderson <br />(This document has been electronically signed) <br />Title: Director of Public Works <br />Mailing address: 14669 <br />City: Hugo <br />Phone (including area code) <br />erald Ave N <br />651 7626326 <br />Date (mm/dd/yyyy): 12/17/2013 <br />State: MN <br />Zip code: 55038 <br />E-mail: sanderson(o)ci.hugo.mn.us <br />Note: The application will not be <br />processed without certification. <br />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 • 5131113 Page 2 of 14 <br />