HomeMy WebLinkAboutCover Letter FormaConstruction Wednesday November 5 2025Company Name Signer Name System Name
Forma Construction Charlie Blankenship WQWebPortal
Washington Department of Ecology
Electronic Submission Cover Letter
WQWebDMR - Permit# WAR314454 - DMR Submission Id: 2012465 - 11/5/2025
1:07:30 PM
Attachments:
Attestation Agreed to at Signing:
I certify I personally signed and submitted to the Department of Ecology an Electronic
Signature Agreement. I understand that use of my electronic signature
account/password to submit this information is equal to my written signature. I have
read and followed all the rules of use in my Electronic Signature Agreement. I believe
no one but me has had access to my password and other account information.
I further certify: I had the opportunity to review the content or meaning of the submittal
before signing it; and to the best of my knowledge and belief, the information submitted
is true, accurate, and complete. I intend to submit this information as part of the
implementation, oversight, and enforcement of a federal environmental program. I am
aware there are significant penalties for submitting false information, including possible
fines and imprisonment.
For Ecology Use Only
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Document Name Or Description Document Name
Submitted Copy of Record for Forma Construction Copy of Record FormaConstruction Wednesday November 5 2025
Report Received: 2025-11-05 13:07
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