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<br /> 4 <br /> <br />Preparer Certification of the Storm Water Pollution Prevention Plan Amendment <br />SWPPP AMENDMENT NO. _____ <br />PROJECT NAME: _________________________________________________________ <br />PROJECT NUMBER: _________________________________________________________ <br /> <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 />properly gather and evaluate the information submitted. Based on my inquiry of the person or <br />persons who manage the system or those persons directly responsible for gathering the information, <br />to the best of my knowledge and belief, the information submitted is true, accurate, and complete. I <br />am aware that there are significant penalties for submitting false information, including the <br />possibility of fine and imprisonment for knowing violations. <br /> <br />________________________________________ _______________________ <br />(Preparer’s Signature) (Date) <br /> <br /> <br />________________________________________ _______________________ <br />(Preparer’s Name and Title) (Telephone Number) <br />