240-25 Exibit A and B.pdf

WQM003-T B. CERTIFICATION BY THE SEWERAGE AUTHORITY Note: This certification is required when a sewerage entity (for example, sewerage authority, utilities authority, municipal utilities authority, joint meeting, etc.) has responsibility for regulating the construction and operation of wastewater treatment and conveyance facilities within the municipality. Name of Facility/Site/Project: Certifying Statement: “As an authorized representative of the below identified agency, I hereby certify that the agency consents to the submission of the above listed application to the Department of Environmental Protection for approval. I further certify that the project as proposed conforms with the requirements of this agency.” Name of Agency Signature of Authorized Representative * Date Print or Type Name Print or Type Position Email Telephone * Authorization to sign for the agency: Resolution # Date (Note: Submit the resolution with this certification. If no such resolution granting authority to sign exists, the full resolution, consenting to the project, must be submitted with this certification.) Last Revised: 8/29/2023