In accordance with Title 40 of the Code of Federal Regulations, Part 403, Section 403.11, information and data provided in this survey which identified the nature and frequency of discharge shall be available to the public without restriction. Request for confidential treatment of other information shall be governed by procedure specified in 40 CFR, Part 2.
This is to be signed by an authorized official of your firm after adequate completion of this form and review of the information by the signing official.
"I have personally examined and am familiar with the information submitted in this document and attachments. Based upon my inquiry of those individuals immediately responsible for obtaining information reported herein, I believe that the submitted information is true, accurate, and complete. I am aware that there are significant penalties for submitting false information, including possibility of fine and/or imprisonment."