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REQUIREMENT ~ ':ak;: r ~+ Yfr r v <br />NAME/TITLE PRINCIPAL EXECUTNE OFFICER I CERTI <br />AM FA FY UNDER PENALTY OF LAW THAT I HAVE PERSONALLY E%AMINED MD <br />MILIM WIiH THE INFORMATION SUlMITTED HEREIN <br />MD BASED ON TELEPHONE DATE <br />Ri <br />h <br />d Mtll ; <br />DII^ <br />E <br />E <br />~ <br />c <br />s <br />ar OBTNN NG THE MFORMATION <br />eE EVE THE <br />SUBMITTED <br />IH ORMATION <br />S <br /> <br />S:nvironmental Manager TRUE. ACCUMTE MD COM0.ETE. I AM AWME THAT THERE ME <br />SIGNIFICMT PENKTIES FOR SUBMITTING FALSE INFORMATION <br />INCLUDING <br />970) 870-2712 <br />B <br />21 <br />96 <br /> , <br />THE POSSIBILITY OF RNE MD IMPRISONMENT. SEE to U.S.C. F 1001 AND ]] <br />C <br />1 1 ]10 <br />U <br />S <br />lPNW>, uWr IN <br />mnma m <br />M <br />A <br />W ! <br />ro 71 <br />0 SIGNATURE OF PRINCIPAL EXECUTNE <br /> <br />TYPED OR PRINTED . <br />. <br />. <br />. <br />y <br />S <br />c <br />. <br />nr• ~ <br />0, <br />00 <br />.newnl.rtir.mlrrpi,omlenrWMrw«n smarrn,wbveral <br />OFFICER OR AUTHORIZED AGENT AREA <br />coOE <br />NUMBER <br />YEAR <br />MO <br />DAV <br />bvmmo. r ~ nnv rnr cnnn r rvn yr nn. •w~n ~ was msrer once sn suecnnronli nerd/ <br />I{,'!•;!n':ATc L.I~i". ='r7F ^'.i5/ ia7N G ;F_5"*L'-~L=- .;lLi'.C !L'1° E~r~ Lonrv n~•*_,v T:- ~= tt+_v~, <br />n~!_'{u nocr'o :q~.. <br />.C~ CLA IM .~. 'I'O' T_.R•l• p~ 1. N.r cn^ 9J7']~. 'i :,^ r.n~r Tn-tUrR-u:•rl^^ (lTr F <br />rn^ r :•,t .._~.. <br />^G P':fY GENOf TV :' OC pnJ TTq- Tn4M ^n ^rr-+a ^_Nr~vYrt no n/ <br />EPA Form 3320-1 108-961 Prevloue edlnona may be ueed . (REPLACES EPA FORM T-40 WHICH MAY NOT BE USED.) ~ <br />„ , n <br />„ <br />, <br />PAGE OF <br /> 7 <br />~ _ I <br />~ ` ^ <br />n ^ ~ T <br />I I , <br />