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Tel: 609-633-7021 / Fax: 609-777-0432 http://www.state.nj.us/dep/dwq/bnpc home.htm 5G2 CERTIFICATION FORM STORMWATER POLLUTION PREVENTION PLAN (SPPP) PREPARATION, IMPLEMENTATION AND ANNUAL CERTIFICATION FOR GENERAL INDUSTRIAL STORMWATER PERMIT NJ0088315 A. NJPDES Permit and Facility Information 1. NAME OF FACILITY: 2. NJPDES No.: 3. PI ID No.: 4. EFFECTIVE DATE OF PERMIT: 5. CERTIFICATION DUE DATE: B. Applicable Certifications Please check which certification you are submitting. SPPP* Pre.

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