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7. Person to contact who is familiar with the information contained in this application: <br />Patti Johnson Director <br />Name Title <br />509-962-7542 509-962-7087 <br />Telephone number Fax number <br />8. Check One: <br />® Permit renewal (including renewal of temporary permits authorized by RCW 90.48.200) <br />Does this application request a greater amount of wastewater discharge, a greater amount of <br />pollutant discharge, or a discharge of different pollutants than specified in the last permit <br />application for this facility? ❑ YES ® NO <br />For permit renewals, the current permit is an attachment, by reference, to this application. <br />® Permit modification ❑ Existing ❑ Proposed discharge <br />unpermitted discharge Anticipated date of discharge: <br />1 certify under penalty of lacy that this document and all attachments tvere prepared under my direction or supervision in accordance <br />with a system designed to assure that qualified personnel properly gather and evaluate the information submitted. Based on my <br />inquiry of the person or persons who manage the system, or those persons directly responsible for gathering the information, the <br />information submitted is, to the best of my knowledge and belief, true, accurate, and complete. I ani mvare that there are significant <br />penalties foi si mitt t tfalse information, including the possibility of a fine and/or imprisonment for knowing violations. <br />Chair, BOCC <br />* Date Title <br />Cory Wright <br />Printed name <br />*Applications must be signed as follows: Corporations, by a principal executive officer of at least the level <br />of vice-president; partnership, by a general partner; sole proprietorship, by the proprietor. If these titles do <br />not apply to your organization, the person who makes budget decisions for this facility must sign the <br />application. <br />The application signatory may delegate signature authority for submittals required by the permit, such as <br />monthly reports, to a suitable employee. You can delegate this authority to a qualified individual or to a <br />position, which you expect to fill with a qualified individual. If you wish to delegate signature authority, <br />please complete the following: <br />Signature of delegated employee <br />Printed name <br />Date <br />Director <br />Title or function at the facility <br />ECY-040-179 (rev. 08/2012) Page 2 of 21 <br />