Rule 13 Certification Of The Plan To Detect Address And Eliminate Illicit Discharges for the Illicit Detection
Download Free Print-Only PDF OR Purchase Interactive PDF Version of this Form
Rule 13 Certification Of The Plan To Detect Address And Eliminate Illicit Discharges for the Illicit Detection Form. This is a Indiana form and can be use in Department Of Enviromental Management Statewide.
Tags: Rule 13 Certification Of The Plan To Detect Address And Eliminate Illicit Discharges for the Illicit Detection, 51271, Indiana Statewide, Department Of Enviromental Management
RULE 13 –
For questions regarding this form, contact:
Certification of the Plan To Detect, Address, and
Eliminate Illicit Discharges for the Illicit Detection and
State Form 51271 (R3 / 4-08)
INDIANA DEPARTMENT OF ENVIRONMENTAL MANAGEMENT
This form must be used to comply with section 14(g) of 327 IAC 1513.
IDEM – Rule 13 Coordinator
100 North Senate Avenue, Rm 1255
Indianapolis, IN 46204-2251
(317) 234-1601 or
(800) 451-6027, ext. 41601 (within Indiana)
http://www.in.gov/idem (Search for Stormwater)
The implementation plan for this MCM must be implemented within
three hundred sixty-five (365) days of the Notice of Intent (NOI)
letter submittal date.
Submit this completed form when the plan has been developed and
Return this completed and signed form, and any required addenda
by mail to the IDEM Rule 13 Coordinator at the address listed in the
box on the upper-right.
CERTIFICATION AND SIGNATURE
The State of Indiana requires ________________________________________________________(MS4 Operator) to
develop and implement a plan to detect and eliminate illicit discharges, including illegal dumping, into the MS4. As part of
this plan, outfall systems within the regulated MS4 area must be mapped throughout the five-year permit term. The plan
must be implemented within three hundred sixty-five (365) days of the Notice of Intent (NOI) letter submittal date.
► The following statement, required by the State of Indiana, and the accompanying signature serve as the required
certification that the program has been developed and implemented per the requirements of 327 IAC 15-13 and
authorized under NPDES permit number INR040_________.
"I certify, under penalty of law, that this plan and all required materials were prepared under my
direction or supervision in accordance with a system designed to assure that qualified personnel
properly gather and evaluate the information. Based on my inquiry of the person or persons
who manage the system, or those persons directly responsible for gathering the information, the
above statement 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."
(typed or printed)
The "authorized signature" required above must be either that of the MS4 operator, or, if another entity is responsible for this MCM, the
The "title" must either be "MS4 operator", or, if a responsible individual signs, the title of that individual and associated MS4 entity
represented (for example, mayor of the City of Indianapolis).
Page 1 of 1
American LegalNet, Inc.