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PERMITTEE NAME/ADDRESS (1kY4 FsWry NwwJLxenm t/Dylrrmr)
<br />NAME r'Uw JLn!1 'J i'. i~ `.'uAL C'1M PANY _
<br />ADDRESS dIiA J; IJ~ ~;it.:, ,. ; FURTA Ls
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<br />FACILITY
<br />LOCATION
<br />NATIO-0ISCHARGEiNONITORNiO REPORT IOMRIPDESI
<br />l2-I51 17-f31
<br />CJOJ2714E, 00U A
<br />PERMIT NUMBER DIBCHMGE NUMBER
<br />MONITORING PERIOD
<br />YEAR MO DAY YEAR MO DAV
<br />FROM f U4 U TO '~f Uh '::
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<br />Form Approved.
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<br />NAME/TITLE PRINCIPAL EXECUTIVE OFFICER I CERTIFY UNDER PENALTY OF LAW THAT I HAVE PERSONALLY E%AMINED AND/
<br />AM FAMILIAR WITH THE INFORMATION BUBMITTED HEREIN; AND BASED ON TELEPHONE DATE
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<br />~ MY INQUIRY OF THOSE INDIVIDUALS IMMEDIATELY RESPONSIBLE F
<br />OBTNNING THE INFORMATION, I BELIEVE THE SUBMITTED INFORMATION ~~
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<br />f TRUE, ACCURATE AND COM0.ETE. 1 AM AWME THAT THERE ME\
<br />INCLUDING
<br />SIGNIFICANT PENALTIES FOR SUBMITTING FALSE INFORMATION T
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<br />1 THE POSSIBILITY OF RNE AND IMPRISONMENT. SEE to U.S.C. f 1001 AND Ba - SIGNATURE OF PRINCIPAL EXECUTIVE
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<br />TYPED OR PRINTED ~,/wnvxi.x.nl,rpr/aem,utf o/bMwnemanNa rgerwal OFFICER OR AUTMORI2ED AGENT CODE NUMBER YEAR MO DAV
<br />COMMENTS AND EXPLANATION OF ANY VIOLATIONS lRe7erence en et7ecnmenb nerel
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<br />EPA Form 3320.1 (08.951 Previous editions mey be used. (REPLACES EPA FORM T-40 WHICH MAY NOT BE USED.) O O i !: 2 / 9 ~ C [ 2 3 _ 1 1 S f~ PAGE / OF
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