Tax2013B- CS150420SWP3 Certification Statement
Storm Water Pollution Prevention Plan Certification
Certification Statement
Project Name Edwood Dr & Highland Meadow Circle Reconstruction - Coppell
This certification is prepared for compliance with the General Permit to Discharge Waste under provisions of Section 402 of the
Clean Water Act and Chapter 26 of the Texas Water Code and may be used in the Storm Water Pollution Prevention Plan (SWP3).
All parties that either individually, or taken together, meet the definition of 'operator," must be permitted and sign a SWP3
certification. Each of these panics must have separate and distinct TPDES permit numbers (e.g. a separate permit is typically needed
for each Owner/Developer, General Contractor, and/or Builder). This form was prepared as a guideline and it is not a required form
for use with the permit. This information may be displayed in alternative form or formats within guidelines set forth in the permit.
"I certify under penalty of law that this document and all attachments were prepared under my direction or
supervision in accordance with a system designed to assure that qualified personnel properly gather and
evaluate the information submitted. Based on my inquiry of the person or persons who manage the system, or
those persons directly responsible for gathering the information, the information submitted is, to the best of my
knowledge and belief, true, accurate, and complete. I am aware there are significant penalties for submitting
false information, including the possibility of fine and imprisonment for knowing violations."
PERMIT #
OPERATOR NAME
SIGNATURE *
DATE NAME PRINTED
TXR150000
Cd Builders Inc
TXR150000
Cityofcoppell
iDI!
*Persons signing this certification must do so in compliance with the signatory requirements of the permit as found at Part V11.6. of
the permit:
For a corporation: by a responsible corporate officer. This means a President, Vice -President, Secretary, Treasurer, Manager of one
or more facilities employing 250+ persons, or Manager for expenditures exceeding $25,000,000 (in 2nd Quarter 1980 dollars)).
For a partnership or sole proprietorship: by a general partner or the proprietor.
For a Municipality, State, Federal, or other public agency: a principal executive officer or ranking elected official.
NCI_LC: s„m_muacr+TOIXYs AL,, 1.4-1, :\u Copyright 0 2013 Project G,mpliance,LLC. All Rights Resmed. 866.228.1586