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F:: <br />CERTIFICATIONS <br />A: Certification of Elimination of Unauthorized Non -Storm Water Discharges <br />Facility Name: <br />Address: <br />WDID No: <br />The undersigned has inspected the facility referenced above and certifies the following: <br />1. That all illicit connections to the facility's storm conveyance system have been <br />eliminated; and <br />2. There are no unauthorized non -storm water discharges from the above referenced <br />site. <br />Name (Print) <br />Title/Position <br />Signature Date <br />B. Owner/Operator Certification <br />"I certify under penalty of law that this document and all attachments were prepared under <br />my direction or supervision in accordance with a system designed to ensure that qualified <br />personnel properly gather and evaluate the information submitted. Based on my inquiry of <br />the person or persons who manage the system, or those persons directly responsible for <br />gathering the information, the information submitted is, to the best of my knowledge and <br />belief, true, accurate, and complete. I am aware of the fine and imprisonment for knowing <br />violations." <br />Name (Print) <br />Signature <br />Title/Position <br />Date <br />2.0 STORM WATER MONITORING AND REPORTING PROGRAM (M&RP) <br />This section describes and establishes QBR= Storm Water Monitoring and Reporting Plan <br />(M&RP) in accordance with the requirements of the GENERAL PERMIT. Specifically, this <br />section describes QBR=s visual observations documentation and reporting requirements, as <br />CATEMMMPREV2.doc <br />