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PERMITTEE NAME/ADDRESS p.r>wdl Fad/iryNmne/Lorerlm I/bgrrmq NATIONILL POLLUTANT DISCHMGE ELIMINATON SYSTEM /NPDESI f0~~~!!~~Approved. ~
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<br />A T T N J I~ r! ~+ ^I . •! A L T t K ~ . ?? ia.~' M (iN E FROM y J4 U l TO -/ 0
<br />,. E ri V 1142 U l11-131 11a-151 !16171 118-191 !3431)` ! i , „J I .L ~. J E .'
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<br />NAMEfTITLE PRINCIPAL E%ECUTNE OFFIOER PERSONALLY E%AMINEO MD
<br />I CERTIFY JNDER PENALTY OF LAW THAT I NAVE
<br />AM PAMILWI W1 H THE INF00.MADON SUBMITTED HEREIN; AND BARED ON /, ~ TELEPHONE DATE
<br />JOHN M WALTERS - Mr INQUIRY OF' THO6E INDIVIDUALS IMMEDIATELY RESPONSIBLE FOP
<br />OBTAINING THE INFORMATION, 1 BELIEVE THE SUBMITTED INFORMATION IS ~ '
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<br />MAIJAGER OF MINE SERVICES TauEE,, AL2UMTE AND COMPLETE. 1 AM AwME TNAr THERE ME
<br />INCLUDING
<br />SIGNIFICANT PENALTIES f00. SUBMITTING FALSE INFORMATION , ~/~ ~?t? 959 - J603 9 7 10 : °.
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<br />THE POS5151L17Y OF RNE AND IMPRISONMENT. SEF 1 B U.S-D. F 1001 MD 77
<br />SIONATUIIE OF PRINCIPAL EXECVTNE
<br />TYPED OR PRINTED U.S.C. f 1016. tPYtrbYa utdr IMAr mnm. nvy NcN.d. Fiws w ro t 10,000'
<br />wumA.inun Mp/smMnt of Mewwn Qirw+NU rg6y.va.1 / OFFICER OR AUTNORIiED AOENY CODE NUMBER YEAR MO DAY
<br />p..'.COMMENTS AND.EXPLA'NATION OF ANY VIOLATIONS lR6ter6ncP se eftscnments.n6re/
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<br />04062/9AOti.'a-Ji~1
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