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PERMITTEE NAME/ADDRESS (lnclude Facdily NamelLoratian JDifferenp NA
<br />NAME
<br />C~L!t~tYO CO~i. CUfPP.`:Y, L.1'.
<br />ADDRESSCO LOM YO AjNE
<br />57,11 STATE NIGH MAT 13 ~°:~~• •;
<br />FACILITY "1EEP.ER r_0 Hlba1 ' ,. .
<br />LOCATION ~ ~ . ~ ~ir~f
<br />ATTN: J. D. H.ARNON, GE"!t;BAL ~A'IAGEW
<br />ELIMINATION SYSTEM (NPDES) Form Approved.
<br />VG~REPOR7 (OMR~ OMB No. 2040-0004
<br />~.1'a•• " (1T- el vI ~1 ,~ ~ Approval expires 05-31-98
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<br />FDI$GHARGE NUMBER F' ~-; ~. ~'x'!l A L ~ ~ ~ MO F A"..
<br />IGTPERIOD. ~S~ 16~.POND TO GGOD SPRiNC CR
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<br />-o O1 ".-03 31 dAl~t.,%` ~,~5CNARGE r,"~"•
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<br />NAMERITL'E PRINCIPAL EXECUTIVE OFFICER I CERTIFY UNDER PENALTY OF LAW THAT I HAVE PERSO NALLY EXAMINED AND / TELEPHONE DATE
<br />AM FAMILIAR WITH THE INFORMATION SUBMITTED HEREIN: AND BASED ON MV 1
<br />
<br />INQUIRY OF THOSE INONIDUALS IMMEDIATELY RESPONSIBLE FOR OBTAINING \
<br />THE INFORMATION, I BELIEVE THE SUBMITTED INFORMATION IS TRUE, _
<br />ACCURATE ANO'COMPLETE. I AM AWARE THAT THERE ARE SIGNIFICANT ~.. ~,
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<br />PENALTIES FOR SUBMTRING FALSE INFORMATION, INCLUDING THE a~
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<br />,~.~]~ M r „~ POSSIBILITY OF FINE AND IMPRISONMENT. SEE 18 U.S.C. § 1001 AND 33 U.S.C. SIGNATURE OF PRINCIPAL'EXEEUTIVE ,~
<br />/ 7/ ~4 ~~H/ 3' ~) ~ /l ~ /f /..
<br />_ § 1318 (Penetttes under these slafNes may include Imes up ro f10,000 end or
<br />TYPED OR PRINTED maximum ~mphsonmenrol Getween6manMS end5yeers.) OFFICER OR AUTHORIZED AGENT
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<br />NUMBER,
<br />YEAR
<br />MO
<br />DAY
<br />COMMENTS AND EXPLANATION OF ANY VIOLATIONS (Reference all attachments here) ~ - ~ :•. ~'~`" ~ ~ ,
<br />SF,tTLEAHLE SOLIDS LIhI: APPLIES U!7LY IF <=.l0YR,2Uf'R PRECIP EYEN1' IS CLAIRF.D. jF CLAI11 A1~PROY&D HY YQCD,
<br />S~5 E IROM LIl1IT5 MLLL dOT 9E APPLIP.D TO RP.PORT2D !i£ASORE~ENTS .:SEE I. A. 2a PG. s r.Q~.::B.OeoBlt of PROOF
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