240-25 Exibit A and B.pdf

Clear Form WQM003-T State of New Jersey Department of Environmental Protection Division of Water Quality Statements of Consent for TWA applications Refer to the attached instructions and provide ALL applicable information. Please attach additional sheets if necessary. 1. GENERAL INFORMATION Applicant/Owner/Operator: Name of Facility/Site/Project: Street Address/Location: City or Town: 2. Verona Township Verona Township WWTF Upgrades Project 600 Bloomfield Avenue Verona State: NJ Zip Code: 07044 CERTIFICATION CHECKLIST (I.E. CERTIFICATIONS SUBMITTED WITH THIS FORM) Note: Refer to this form’s instructions for certification applicability. Certification A: Governing Body (i.e. municipality where project is located) a. Certification(s) Submitted with this Form? ✔ b. Number of Certifications Submitted with this Form? 1 Yes No Yes No Yes No Yes No Yes No (Note: More than one certification is required when multiple governing bodies are impacted by the project.) Certification B: Sewerage Authority a. Certification Submitted with this Form? Certification C: Wastewater Conveyance System Owner a. Certification(s) Submitted with this Form? ✔ b. Number of Certifications Submitted with this Form? 4 (Note: More than one certification is required when multiple wastewater conveyance system owners are impacted by the project.) Certification D: Wastewater Treatment Facility Owner a. Certification Submitted with this Form? Certification E: District Sludge Management Lead Planning Agency a. Certification Submitted with this Form? Last Revised: 8/29/2023