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    Doc073 PDF

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    Steve Wilson

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    © All Rights Reserved
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    Doc073 PDF

    Uploaded by

    Steve Wilson
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    DOC073.pdf

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    Doc073 PDF

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    f

    AUS
    PRIME CONTRACTOR CERTIFICATIONA 97
    LARGE CONSTRUCTION GENERAL PERMIt
    Coverage No. MSRIO q County ki p5
    (Fill in yOLIr Certificate of (overage Number and County)
    fly conupleling ituid submitting this form to MDEQ, the prIme couitractor is ceiIIting thuiit (I) they lone olselItlunul control over the erosion
    nod sediment contnii specifications (including (lit ability to moke uuiodlflcationi to such specifications) or (2) they have daytoday o
    operatIonal control of those ucticitics at the site necessary to ensure complIance with (lie SWIPP and applicable permit conditions.
    the owner(s) of the proaerty and div prime c,,ntractor aisciatccl with regulated construction activity out the properly have joint gad several tN
    respnnslbility for eDillIdlance with the pernult. Notwlth,tantling any permIt condItion to the contn, the coverage recIpient and any person
    who causes pollutIon of waters of the stale or places waste in a location where they are likely to cause itollution or any waters of the state
    shall remain responsIble under applicable federal and state laws and rcgulations and applicnhle permits. Mi!4.
    PRIME CONTRACTOR INFORMATION

    PRIME CONTRACTOR CONTACT PERSON: j %JIIONE NLJiBER: gi) t4 3q86


    PRIMK coNrRAnon COMPANY: Vccre ut p . Lt C
    PRIME CONFRAC1014 srlwl:I (I.O. BOX): lit,
    PRIME CONTRACTOR CITY: O STATE MS ZIP: o

    OWNER

    OWNER CONIACE PERSON: DAQ 0 PhONE NUNIHER: (gj_j I to

    OWNER COMPANY NAME: Uy; o4 Js: s Me ea\ Ce-e


    PROJECT INFORMATION

    PROJECT NAME: rceoi p .ch ts e%a4. o


    DESCRIrIION OF CONStRUCtION ACTIVIfl: SI a era\ Qg.e)r Na\o .
    -J

    %CqLS O-w. vc DOS0 S


    PIlYSl(:AL Silt ,DDRESS cli the physical address is not available indicate tltc tienrest ismued rand. For linear projects,
    indicate (he Iteginning of th project and idetitify all counties the project traverse.,)
    SlREEl: Q4ca.n- U,,;.aerc,,*-i DtiE
    CItY: SP.c t0 COUNTY: 4jms

    I certily that I Inn the prime contractor for thu project and wilt comply with all the rcq ulrements In the above referenced Nenenal NPDES
    permit. I further ceni5 under penalty of Ian tluiut this document and all attach ments were prepared under my direction or supervision in
    accordance with a system designed to assure that qualified personnel properly pthered and evaluated the information submitted. Based on
    my hiquhy of the petn or pcnnnt who rnnnagc Ihe ey.tem, or thaw penons dIrectly responsible for gathering the informatIon, the
    Information subml ted Is best of toy knowledge and belief. tnie, accurat, and complete. I am aware that there are significant
    ntlrination,incllng the possibility of fine and imprIsonment Ion knowineviolstlons.

    Prime Contractor Siguflurt

    ?ru_
    PHiiTINiic
    cin-nm cER S

    [hIs application shall he signeul as follow.: 11,1, Prime (,,otraclori (eesiflcoth,n marnt shall lie wlunslttc,l to:
    For a corporation, by a ropoitible corponic omc,r.
    loris partnership, by a patrol parhier. ChIef, nvln,iti,uenhitl Permit. Division
    For a .ok proprlclonlilp, by the proprietor. MS Department at InInj,,n,cntal Quails), Offiec at Pollution totutrul
    For municipal, state .rothcr public facility, by piliacipal aec,utI.c 1.0, Pin 216)
    officer, mayor, or nahing elected official. Jackson, Misituippi 3922$

    Revised: 121/16/10

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