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SIGNATURE AUTHORIZATION FORM <br /> l FOR GRANT/LOAN RECIPIENTS <br /> Department of Ecology <br /> Water Quality Program <br /> _ PO Box 47600 <br /> Olympia,WA 98504-7600 <br /> WASHINGTON STATE Phone: (360)407-6600 <br /> DEPARTMENT OF <br /> ECOLOGY FAX: (360)407-7151 <br /> Name of-Organization Date Submitted <br /> Project Title Agreement Number. <br /> East Grand Stormwater & Sewer G1200541 <br /> • <br /> AUTHORIZING SIGNATORY <br /> Signature - Print or Type Title/Term of Office <br /> Ray Stephanson Mayor <br /> • <br /> AUTHORIZED TO SIGN AGREEMENT AMENDMENTS . <br /> Signature • Print or Type • Title <br /> David H. Davis Public Works Director <br /> _010: <br /> AUTHORIZED TO SIGN REQUEST FOR REIMBURSEMENT <br /> Signature Print or Type Title <br /> David H. Davis Public Works Director <br /> - 2 <br /> ECY 070-206 (Rev. 01/2006) Ecology is an equal opportunity agency. <br />