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12 <br />IOWASAI <br />Application for Registration to Obtain Sensitive <br />Infrastructure Information <br />In accordance with OWASA's Administrative Guide titled PROTECTION OF SENSITIVE <br />INFRASTRUCTURE INFORMATION, I hereby provide the following information necessary to <br />obtain sensitive maps, plans, data or other engineering information pertaining to OWASA's <br />water and wastewater infrastructure. I further understand that registration is valid for a period of <br />one year from date of registration (all fonns expire on 31 December of the year of expiration) <br />after which I will be required to update and renew registration. <br />I further agree and understand that both I and /or my organization is prohibited from otherwise <br />copying or distributing the information to anyone outside of my immediate business concerns for <br />any purposes not directly related to the projects for which the information was obtained. <br />I hereby designate the following individuals as agents of our organization and request they be <br />allowed to obtain information as described above. As a condition of any approval granted, we <br />will immediately notify OWASA in writing upon termination of employment of any employees <br />listed below. We also request to be allowed to add employees in a similar manner. <br />Authorized Individuals: <br />Printed Name: <br />Address: <br />Phone Number: <br />Email Address: <br />* Professional License Type and Number (if applicable): <br />Signature: <br />Date: <br />OWASA O ce Use Onl <br />This registration approval becomes effective and will expire on December 31, <br />OWASA Approval: <br />Signature Date <br />