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DO NOT SUBMIT THIS PAGE WITH APPLICATION <br />If you have questions about this form, contact the following Ecology staff: i <br />Localion <br />Contact iNarne <br />Plume <br />I b.-mail <br />City of Seattle, Kitsap, Pierce, and <br />Josh Klimek <br />360-407-7451 <br />iok1461(a1ecy.wa.go <br />Thurston counties <br />Island, King, and San Juan counties <br />Elaine Tomita <br />360-407-7229 <br />ewor461(alecy.wa.gov <br />Adams, Asotin, Columbia, Ferry, <br />Charles Gilman <br />360-407-6437 <br />chgi4610,ecy.wa.gov <br />Franklin, Garfield, Grant, Lincoln, <br />Pend Oreille, Skagit, Snohomish, <br />Spokane, Stevens, Walla, Whatcom, <br />and Whitman counties. <br />Benton, Chelan, Clallam, Clark, <br />Joyce Smith <br />360-407-6858 <br />iosm461Calecy.wa.pov <br />Cowlitz, Douglas, Grays Harbor, <br />Jefferson, Kittitas, Klickitat, Lewis, <br />Mason, Okanogan, Pacific, Skamania, <br />i <br />Wahkiakum, and Yakima counties. <br />More information is available at: h.UT.,/lwww.ecy.wa.-gov/programsAygIstormwaterlconstructfonl.. <br />To ask about the availability of this document in a version for the visually impaired, call the Water Quality Program at 360- <br />407-6401. Persons with hearing loss, call 711 for Washington Relay Service. Persons with a speech disability, call 677- <br />833-6341. <br />EGY 020 85 (Rev, 06109) 1 <br />/ t- <br />