9826 7TH AVE SE 2025-06-25 - Laserfiche WebLink

Inspector - Certification: This section must be completed by the person who conducted the site inspection prior to submitting this form to the person with signature authority (see Permit Condition G2) or a duly authorized representative of that person. ❑ The facility is in compliance with the terms and conditions of the SWPPP and the Industrial Stormwater General Permit. ❑ The facility is out of compliance with the terms and conditions of the SWPPP and the Industrial Stormwater General Permit. This report includes the remedial actions that must be taken to meet the requirements of the SWPPP and permit, including a schedule of implementation of the remedial actions. `7 certify that this report is true, accurate, and complete, to the best of my knowledge and belief." Inspector's Name — Printed Inspector's Signature Inspector's Title Date Permittee — Certification: ❑ The facility is in compliance with the terms and conditions of the SWPPP and the Industrial Stormwater General Permit. ❑ The facility is out of compliance with the terms and conditions of the SWPPP and the Industrial Stormwater General Permit. This report includes the remedial actions that must be taken to meet the requirements of the SWPPP and permit, including a schedule of implementation of the remedial actions. `7 certify under penalty of law, that this document and all attachments were prepared under my direction or supervision in accordance with a system designed to assure that qualified personnel properly gathered and evaluated the information submitted. Based on my inquiry of the person or persons who manage the system, or those persons directly responsible for gathering information, the information submitted is, to the best of my knowledge and belief, true, accurate, and complete. 1 am aware that there are significant penalties for submitting false information, including the possibility of fine and imprisonment for knowing violations." PRINTED NAME of person with Signature SIGNATURE of person with Signature Authority (permit DATE Authority (permit condition G2.A) or a Duly condition G2.A) or a Duly Authorized Representative' Authorized Representative' 'A person is duly authorized representative only if 1) the authorization is made in writing by a person described in Permit Condition G2.A and submitted to Ecology, and 2) the authorization specifies either an individual or a position having responsibility for the overall operation of the regulated facility, such as the position of plant manager, superintendent, position of equivalent responsibility, or an individual or position having overall responsibility for environmental matters.