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Required for new facilities only: <br /> • Copy of any draft or final environmental impact statement or environmental assessment worksheet regarding the <br /> facility. <br /> XII. Certification <br /> Certification must be signed by an authorized company representative who is a member of company management as defined in <br /> Minn. R. 7001.0060. <br /> I hereby certify, under penalty of law, that I have personally examined and am familiar with the information submitted on <br /> this and all attached documents. I believe that the submitted information is true, accurate and complete. <br /> Signature: Date: <br /> Print name: Title: <br /> t-a3-25 <br /> 4/4/07 Page 8 of 8 <br />