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Form 2c - Application For Permit To Discharge Wastewater - Existing Manufacturing, Commrecial, Mining And Silviculture Operarions - Idaho Department Of Environmental Quality Page 14

CONTINUED FROM THE FRONT

VII. BIOLOGICAL TOXICITY TESTING DATA

Do you have any knowledge or reason to believe that any biological test for acute or chronic toxicity has been made on any of your discharges or on a receiving water in

relation to your discharge within the last 3 years?

YES (identify the test(s) and describe their purposes below)

NO (go to Section VIII)

VIII. CONTRACT ANALYSIS INFORMATION

Were any of the analyses reported in Item V performed by a contract laboratory or consulting firm?

YES (list the name, address, and telephone number of, and pollutants analyzed by,

NO (go to Section IX)

each such laboratory or firm below)

C. TELEPHONE

D. POLLUTANTS ANALYZED

A. NAME

B. ADDRESS

(area code & no.)

(list)

IX. CERTIFICATION

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 gather and evaluate 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, to 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.

A. NAME & OFFICIAL TITLE (type or print)

B. PHONE NO. (area code & no.)

C. SIGNATURE

D. DATE SIGNED

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