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PERMITTEE NAME/ADDRESS (Inc(ade Faciliry Namd(ncarion ijDigerenQ
<br />NAME 90Ni:.- 4F.S'.~I1pi
<br />ADDRESS RO+IE '+0. !. ~'Tk=
<br />P.O. HAY 4•!i
<br />PA04.LA C:1 81+1211
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<br />LOCATIONAO 1 I T: -
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<br />NATIONAL POLLUTANT DISCHARGE ELIMINATION SYSTEM (NPDES)
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<br />PERMIT NUMBER DISCHARGE NUMBER
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<br />(30.31) 82.331 (34151 (76-T1) RB-~9) (3D3f/
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<br />Form Approved.
<br />OMB No. 2040-000a
<br />Approval expires OS31-9B
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<br /> (3 Card Ony) GUANTITY OR LOADING (4 Card Ony) GUANTITY OR CONCENTRATION NO. FREOUENC SAMPLE
<br />PARAMETER (46-53) 59-61 38-45 (46-53) (54-61) EJC OF TYPE
<br />(32-37) AVERAGE MAXIMUM UNITS - MINIMUM AVERAGE MAXIMUM UNITS
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<br />NAME/TITLE PRINCIPAL EXECUTIVE OFFICER I CERTIFY UNDER PENALTY OF
<br />AM FAMILIAR Wm{THE INFORM LAW THAT I HAVE PERSO
<br />ATION SUBMITTED HERE NALLY E7(AMINED AND
<br />IN: AND BASED ON MV
<br />' TELEPHONE DATE
<br /> INQUIRY OF THOSE INDIVIDUAL S IMMEDIATELY RESPON SIBLE FOR OBTAINING
<br /> THE INFORMATION, I BELIEV E THE SUBMITTED IN FORMATION IS TRUE,
<br /> ACCURATE AND COMPLETE. I AM AWARE THAT TH
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<br />TYPED OR PRINTED 5 1319. (Penellies ntler these sran+res may Inclutla lines up b 510,000 and or
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<br />COMMENTS AND EXPLANATION OF ANY VIOLATIONS (Helerenc90/1 attachments here)
<br />'JfTTLEABLE SOLIDS LICIT 3PPLIES ONLY IF C=LOYR,2YHR P4£CTP °YF4T TS CLAT11r°D• IF CL+1TN APFPOYF.D Sy :I,Cf1,
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<br />EAA orm 2o-1 (08.95) Previous a Itions may not be used. ~ ~ ( EP CES E A F T' W 1 MA\' NO B D:) , ~ B,I ~ S /O ~ n Z i ~_ 7 ~ ~ ~ PAGE , OF
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