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Eastern Washington Phase 11 Municipal Storrnwaler Permil <br />Part 8 - Certification <br />I 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. The information submitted is, to the best of <br />my knowledge and belief, true, accurate, and complete. I am aware that there are significant <br />penalties for submitting false information, including the possibility of fine and imprisonment for <br />knowing violations. <br />Print or type name of responsible official or representative Title <br />Signature of responsible official or representative <br />Date <br />If yore need this document in a format for the visually impaired, call the Water Quality Program at <br />360-407-6600. Persons with hearing loss can call 711 for Washington Relay Service. Persons with a <br />speech disability can call 877-833-6341, <br />August 1, 2014 Appel?dix 5 - Notice of hsrew for Coverage Page 5 of 5 <br />