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2. Acknowledgement of Receipt

   I have had access to the Town of Fort Mill Stormwater Department’s document:

    “Getting the Word Out: The role of local governments in implementing the NPDES stormwater program for construction sites”

   and acknowledge receipt of this document.

   I understand and agree that this has been received and that I've read the above document and understand the information therein. I agree to abide by the rules, regulations and procedures listed in the document, and understand that I can contact personnel in the Stormwater Department if I have questions or concerns.

   I also understand that it is my responsibility to share the information therein with any staff, subcontractors or others on the job sites I manage, thus ensuring that sites under my purview are in compliance with all applicable rules and regulations.

4. I agree with the above statements*

   1. I agree
5. Date of Acknowledgement*
   Date of Acknowledgement
7. First Name*
8. Last Name*
9. Title*
11. Phone Number*
12. Email Address*
14. Company Name (Doing Business As)*
15. Work Site Name*
17. Work Site Address*
19. City*
20. State*
21. Zip Code*
23. Company Mailing Address*
25. City*
26. State*
27. Zip Code*
Leave This Blank:


29. 1. Receive an email copy of this form.
30. Email address

    This field is not part of the form submission.

31. Submit

* indicates a required field