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

SECTION M. LICENSED SITE REMEDIATION PROFESSIONAL INFORMATION AND STATEMENT LSRP ID Number: 668140 First Name: Rose Last Name: DeLorenzo Phone Number: (973) 585-9034 Ext: Fax: (973) 240-1818 Mailing Address: 26 Columbia Turnpike City/Town: Florham Park State: NJ Zip Code: 07932 Email Address: rdelorenzo@matrixneworld.com This statement shall be signed by the LSRP who is submitting this notification in accordance with SRRA Section 16 d. and Section 30 b.2. I certify that I am a Licensed Site Remediation Professional authorized pursuant to N.J.S.A. 58:10C to conduct business in New Jersey. As the Licensed Site Remediation Professional of record for this remediation, I: [SELECT ONE OR BOTH OF THE FOLLOWING AS APPLICABLE]: directly oversaw and supervised all of the referenced remediation, and\or personally reviewed and accepted all of the referenced remediation presented herein. I believe that the information contained herein, and including all attached documents, is true, accurate and complete. It is my independent professional judgment and opinion that the remediation conducted at this site, as reflected in this submission to the Department, conforms to, and is consistent with, the remediation requirements in N.J.S.A. 58:10C-14. My conduct and decisions in this matter were made upon the exercise of reasonable care and diligence, and by applying the knowledge and skill ordinarily exercised by licensed site remediation professionals practicing in good standing, in accordance with N.J.S.A. 58:10C-16, in the State of New Jersey at the time I performed these professional services. I am aware pursuant to N.J.S.A. 58:10C-17 that for purposely, knowingly or recklessly submitting false statement, representation or certification in any document or information submitted to the board or Department, etc., that there are significant civil, administrative and criminal penalties, including license revocation or suspension, fines and being punished by imprisonment for conviction of a crime of the third degree. LSRP Signature: Date: LSRP Name/Title: Rose V. DeLorenzo, CHMM, LSRP Company Name:

of a crime of the third degree. LSRP Signature: Date: LSRP Name/Title: Rose V. DeLorenzo, CHMM, LSRP Company Name: Matrix New World Engineering No changes to contact information since last submission Completed forms should be sent to: Bureau of Case Assignment & Initial Notice Site Remediation Program NJ Department of Environmental Protection 401-05H PO Box 420 Trenton, NJ 08625-0420 HDSRF Application Part I Page 4L of 4 Version 1.3 12/11/13