HomeMy WebLinkAboutMunicipal Compliance Certification MARTIN D. FINNEGAN
~ TOWN ATTORNEY
mar tin.finnegan~town.southold.ny.us
JENNIFER ANDALORO
ASSISTANT TOWN ATTORNEY
jennifer.andaloro@town.southold.ny.us
LORI M. HULSE
ASSISTANT TOWN ATTORNEY
lori.hulse@town.southold.ny.us
SCOTT A. RUSSELL
Supervisor
Town Hall Annex, 54375 Route 25
P.O. Box 1179
Southold, New York 11971-0959
Telephone (631) 765-1939
Facsimile (631) 765-6639
OFFICE OF THE TOWN ATTORNEY
TOWN OF SOUTHOLD
September 29, 2010
RECEIVED
New York State Department of Environmental Conservation
Division of Water
MS4 Permit Coordinator
625 Broadway, 4th Floor
Albany, NY 12233-3505
OCT 1
Southot~ Town C~erl~
Attention: Mr. Bradd Larson
RE: MS4 Annual Report NYR20A524
To Whom It May Concern:
As requested in a letter from the DEC dated September 22, 2010, enclosed
please find a Municipal Compliance Certification (MCC) with an original signature of the
Town of Southold Supervisor, Scott A. Russell,
Please confirm in writing that you have received the enclosed MCC and that the
Annual Report submitted by the Town of Southold is complete.
Thank you for your attention.
Very truly yours,
"
~Attorney
JAJlk
Enclosure J
cc: Ms. Elizabeth A. Neville, Town Clerk (w/encl.)
Mr. James Richter, Town Engineering Inspector (w/encl.)
Mr. John Sepenoski (w/encl.)
3165331518
MS4 Municipal Compliance Certification(MCC) Form
MCC form for period ending March 9,~0 I
SPDES ID
Section 4 - Certification Statement
"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 gathered and evaluated 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, the best of my knowledge and belief, true, accurate, and complete. I am
aware that there are significant penalties for submitting false information, including the possibility of
fine and imprisonment for knowing violations."
This form must be signed by either a principal executive officer or ranking elected official, or duly
authorized representative of that person as described in GP-0-08-002 Part VI.J.
First Name
Title (Clearly prinl tire of individual ~ report)
ISIU p ~2 RV I $ 0R
I I I I
Signalu~____~
MI Last Name
Dale
Send completed form and any attachments to the DEC Central Office at:
MS4 Permit Coordinator
Division of Water
4th Floor
625 Broadway
Albany, New York 12233-3505
MCC Page 4
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