2018-10-18 Signer for use of NetDMR System-Al SchoemakerSubscriber Agreement
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Agency: Nebraslut Department of Environmental Quality
Subscriber Agreement Number: Oc8jObd8-98c3-4f48-b629-6659JO968a2d
Generated On: 2018-10-1715:37:21.0
Account Reference: 32906
NetDMR SubscriberAgreentent Instructions Page
This form can be usedforpernuts issued by: Nebraska Department of Environmental Quality, hereafter referred to as "the
Regulatory Authority ".
A. Signatory Authority Information
The Signatory Authority is the individual that intends to sign DMRs and signs this Subscriber Agreement in Section E.
User Name:
NE3117905
Subscriber Name:
Allen Schoemaker
Organization:
Blair, Nebraska
Email Address:
ars@blairnebraska.org
Phone Number:
(402) 426-4191
B. Permit Information
Signing privileges are requested for the following permits:
Permit ID
Facility Name
Facility Address
Relationship
Authorized By
NE0113913
BLAIR POTABLE WTP
742 EAST FARIVIEW DRIVE
Facility
James Realph
BLAIR, NE 68008
C. Terms and Conditions
• PURPOSE: This agreement creates a legally binding obligation for the signer of the Agreement (the Responsible Official
and/or Signatory Authority) to abide by the terms and conditions for use of the NetDMR System, and memorializes a mutual
understanding that the signer of this agreement is as legally bound, obligated, and responsible by use of the assigned electronic
signature as by a hand-written signature.
• ACCEPTANCE & EFFECT: Acceptance of this agreement by the Regulatory Authority shall be evidenced by notice from the
Regulatory Authority, provided electronically, that this agreement has been approved.
• SUBMITTAL & RECEIPT: A Document shall be deemed to have been submitted when it is accessible to the Regulatory
Authority. A document shall be deemed to have been received when it can be fully processed. No document shall satisfy any
reporting requirement until it is received.
• VERIFICATION: In accordance with the associated certification statement, the signer of the Agreement is responsible for the
truth and accuracy of the content of each submission. The signer of the Agreement also has an affirmative obligation to check
the accuracy of the document as received by the Regulatory Authority and to notify the Regulatory Authority promptly if the
document was sent without authorization or differs in substance in any way from the document that was submitted.
• INABILITY TO TRANSMIT OR FILE REPORTS ELECTRONICALLY: No party shall be liable for any failure to perform
its obligations in connection with any Electronic Transaction or any Electronic Document, where such failure results from any
act or cause beyond such party's control which prevents such party from electronically transmitting or receiving any
Documents, except that the signer of the Agreement (Responsible Official and/or Signatory Authority) is nonetheless required
to submit records or information required by law via other means, as provided by applicable law and within the time period
provided by such law.
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Subscriber Agreement
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• SEVERABILITY: Any provision of the Agreement which is determined to be invalid or unenforceable will be ineffective to
the extent of such determination without invalidating the remaining provisions of this Agreement or affecting the validity or
enforceability of such remaining provisions.
TERMINATION AND RENEWAL: The Agreement may be terminated at any time by the Regulatory Authority. Upon
termination of this agreement, the associated ability to submit electronic information through the NetDMR system will be
terminated. The Regulatory Authority will provide notification of termination, including the date on which termination takes
effect. A new Responsible Official and/or Signatory Authority must resubmit this form at the time that a new permit
application is submitted or when Responsible Official and/or Signatory Authority responsibility transfers from one person to
another.
-Note: Termination of this agreement may eliminate the ability to comply with permit requirements for any continuing
operations. Paper DMR Reports will only be accepted under this permit where the permittee has provided sufficient
justification and obtained prior approval from the Regulatory Authority.
D. Responsible Official Authorization
The Responsible Official is the appropriate individual identified under 40 CFR § 122.22(a) with the authority to sign permit
applications, reports, and other permit -required submittals (e.g., DMRs). The Responsible Official can also delegate the authority to
electronically sign DMRs to a duly authorized representative(s) as described in 40 CFR § 122.22(b).
Permit ID(s): NEO 113913
I, James Realph Mayor, have the authority to enter into this Agreement for BLAIR POTABLE WTP and Permit ID NEO 113913 under
the applicable standards. l request Nebraska Department of Environmental Quality grant Allen Schoemaker the ability to submit DMRs
for Permit ID NEO 113913.
James Realnh
Mayor
Responsible Official Signature Title Date
Responsible Official Phone
E. Signatory Authority Signature
The Signatory Authority is the NetDMR user that submits this agreement to request approval to electronically sign DMRs. The
Signatory Authority has the authority to sign DMRs under 40 CFR § 122.22(a) or is a duly authorized representative(s) who has been
delegated the authority to electronically sign DMRs by the Responsible Official as described in 40 CFR § 122.22(b).
Permit ID: NEO 113913
I, Allen Schoemaker, am authorized by the signatory authority named in Part D of this document, who does have the authority under
the applicable standards, to enter into this agreement for BLAIR POTABLE WTP and Permit ID NE0113913.
By submitting this application for NE0113913, I, Allen Schoemaker, have read, understand, and accept the terms and conditions of this
subscriber agreement. I certify under penalty of law that I have personally examined and am familiar with the information submitted in
this application and all attachments and that, based on my inquiry of those persons immediately responsible for obtaining the
information contained in the application, I believe that the information is true, accurate and complete. I am aware that there are
significant penalties for submitting false information, including the possibility of fine and imprisonment.
Signatory Authority Signature
Print this form, save a copy for your records, and mail to:
Nebraska Department of Environmental Quality
Attn: NPDES Permits and Compliance
Title Date
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