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Page 35 <br /> Attachment M Annual Certification of Compliance Form <br /> ■ By June 15" of each year, the Contractor shall complete and submit this form to CIWMD for <br /> approval as specified in Section 100.3 of the SWPPP. Annual certification is based on the <br /> inspections required in the SWPPP. <br /> Annual Certification of Compliance for the Construction Contractor <br /> Project Name: Tracy Tire Fire Remediation Site <br /> Contract Number: IWM-C2017 <br /> Contractor Name: Sukut Construction, Inc. <br /> Contractor Address: 4010 West Chandler— Santa Ana, CA 92704 <br /> Construction Start Date: 20 Mar 2003 Completion Date: <br /> Description of Work: <br /> Work Now in Progress: <br /> Work Planned for Next 12 Months: <br /> "I certify under a penalty of law that this document and all attachments were prepared under my <br /> direction or supervision in accordance with a system designed to ensure that qualified personnel <br /> gather and evaluate the information submitted. <br /> Based on my inquiry of the person or persons who manage the system or those persons directly <br /> responsible for gathering the information, to the best of my knowledge and belief, the information <br /> submitted is true, accurate and complete. I am aware that there are significant penalties for <br /> submitting false information, including the possibility of fine and imprisonment for knowing <br /> violations." <br /> Signature Date <br /> Prepared: April 12, 2003 <br />