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Continued <br />Certification Statement I <br />"l certify under penalty of law that this document and all attachments were prepared under my <br />direction or supervision in accordance with a system designed to assure that qualified personnel <br />properly gather and evaluate the information submitted. Based on my inquiry of the person or <br />persons who manage the system, or those persons directly responsible for gathering the <br />information, the information submitted is, to the best of my knowledge and belief, true, accurate, <br />and complete. 1 am aware that there are significant penalties for submitting false information, <br />including the poss' ility of fine and imprisonment for knowing violations." <br />S nature of Responsible Official Title <br />Date <br />Must be signed by the Responsible Official or a duly authorized representative; see WAC 173-308-310(10)(b). <br />Submission Instructions <br />Please note, you MUST submit multiple copies, and deadlines vary depending on submission format. <br />Deadlines by submission type: <br />By Mail: Postmarked no later than 11:59 PM Monday March 9, 2020. <br />In Person: Delivered to office no later than 5:00 PM Monday March 9, 2020. <br />By Email (when acceptable, see submission instructions below): Received no later than 11:59 PM <br />Monday March 9, 2020. <br />Submission Type <br />Location <br />Original Hard Copy <br />Regional Office (see regional contact and address information below) <br />Copy (electronic <br />Other regions where your biosolids, sewage sludge, or septage will be treated, <br />preferred) <br />stored, disposed, or land applied. (see regional contact and address information <br />below) <br />Copy (electronic <br />Headquarters Office (see Region Contact Information and Addresses table <br />preferred) <br />below.) <br />Copy (electronic <br />You MUST send a copy to Local Health Jurisdictions where your biosolids, sewage <br />preferred) <br />sludge, or septage will be treated, stored, disposed, or land applied, unless the <br />Health Jurisdiction has declined to receive a copy. <br />ECY 070-300 (Revised 1/20) <br />