14-18 Exhibit-Application for Discharge Site Remediation Funds from HDSRF.pdf

New Jersey Department of Environmental Protection Site Remediation Program HDSRF APPLICATION – 25% MATCHING GRANT REMEDIAL ACTION CERTIFICATION – PART V THIS CERTIFICATION IS REQUIRED FOR ALL PRIVATE ENTITY APPLICANTS APPLYING FOR A 25% MATCHING RA GRANT This certification shall be signed as follows: For a corporation, by a principal executive officer, at least the level of vice president; for a partnership, by a general partner; for a sole proprietorship, by the proprietor; for other than above (i.e. homeowner/individual), the person with legal responsibility for the site. I hereby certify that A) The requestor has a net worth of not more than $2,000,000 at the time the relevant costs are incurred; and B) The requestor will implement a remedial action using an innovative technology or a limited restricted or unrestricted use remedial action. Signature Name/Title Company Sworn to and Subscribed Before Me On this date of Notary HDSRF Application Part V Page 1 of 1 Version 1.3 12/11/13