Laserfiche WebLink
State of Florida <br /> DEPARTMENT OF ENVIRONMENTAL PROTECTION <br /> Central Florida District <br /> Suite 232 <br /> 3319 Maguire Boulevard <br /> Orlando, Florida 32803 -3767 <br /> CERTIFICATION FOR QUARTERLY REPORT ON GROUND WATER MONITORING <br /> GMS# 3031C00527 Date <br /> DEP Permit # FL0041637/OGC File No. 044977 <br /> IRCUD/West Regional WWTF <br /> Installation Name <br /> Address City State Zip County <br /> Owner or Authorized Representative ' s Name Title <br /> Method of Discharge <br /> Type of Industry <br /> Report for Period to <br /> date date <br /> I certify under penalty of law that I have personally examined and am familiar with the information submitted in this document and all attachments and <br /> that, based on my inquiry <br /> of those individuals immediately responsible for obtaining the information, I believe that the information is true, accurate, and complete. I am aware <br /> that there are significant <br /> penalties for submitting false information, including the possibility of fine and imprisonment. <br /> Owner of Authorized Representative ' s Signature Date <br /> DEP Form 62-620.910( 10), Effective November 29, 1994 21 D.E.P. - ORLANDO <br /> EXHIBIT NO. 3 <br />