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State of California — Department of Fish and Wildlife NOTIFICATION OF LAKE OR STREAMBED ALTERATION FISH AND GAME CODE SECTION 1602 DFW 2023 (REV. 01/01/18) Page 9 15. SITE INSPECTION Check one box only. BIn the event the Department determines that a site inspection is necessary, I hereby authorize a Department representative to enter the property where the project described in this notification will take place at any reasonable time, and hereby certify that I am authorized to grant the Department such entry. ❑1 request the Department to first contact (insert name) at (insert telephone number) to schedule a date and time to enter the property where the project described in this notification will take place. I understand that this may delay the Department's determination as to whether a Lake or Streambed Alteration Agreement is required and/or the Department's issuance of a draft agreement pursuant to this notification. 16. DIGITAL FORMAT Is any of the information included as part of the notification available in digital format (i.e., CD, DVD, etc.)? DYes (Please enclose the information via digital media with the completed notification form) []No 17. SIGNATURE 1 hereby certify that to the best of my knowledge the information in this notification is true and correct and that I am authorized to sign this notification as, or on behalf of, the applicant. I understand that if any information in this notification is found to be untrue or Incorrect, the Department may suspend processing this notification or suspend or revoke any draft orfinal Lake or Streambed Alteration Agreement issued pursuant to this notification. I understand also that if any information In this notification is found to be untrue or incorrect and the project described in this notification has already begun, I and/or the applicant may be subject to civil or criminal prosecution. I understand that this notification applies only to the prcject(s) described herein and that I and/or the applicant may be subject to civil or criminal prosecution for undertaking any project not described herein unless the Department has been separately notified of that project in accordance with Fish and Game Code section 1602 or 1611. ( -///� 6p, ) e L - or Applic 's Aut r d Representative Date Print Name