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1. <br />PERMTf1EE NAME/ADORESS f/weYiisWryNr/lonaw /DtS~sa) <br />NAME d!1 -.,i. 4" .. r Sv rT !. . <br />ADDRESS ? O ~ I :, tf ~' 1 .. 1 . _ ' w I V r. <br />P.J. :"1~' I/~''' <br />P 4 J I I P ~_ II '. -. <br />FACILITY , . S :. ? `. i `~ ~. i .. .. <br />LOCATION <br />T B <br />., <br />NAnoNAL PouvrANT wscN.wDE EtAMInAn(Ir. f: ~.. rl ;off c ~-,i <br />DISCH? RAE MONRORINO REPORT D~91 <br />PERMIT NUMBER DIaCNAROE NUMBET <br />MONITORING PERIOD <br />YEAR MO DAY YEAR MO DAY <br />FROM 4 1 ''.~ j (: 1 TO rl ~, T T ~~ T <br />/JQPJ1 !77431 U6P51 /Pl4]JI IPA-]91 /3Q9f1 <br />Forth Apprv ~~~- <br />!" T N F' P. T 3 1 T'1 ~ ~ " £ 1P~~~o..1An6~{~u: <br />AjiRrovel'ei<pire~ 505-31-98 <br />F ono'^I;C) 1. <br />,~y-;. <br />. ,. ,. 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'!t i tREQUIREMENT .. t"I1T~Q ~A°7 A' :~{'T: .i.1K "';/L <br />NAME/TITLE PRINCIPAL EXECUTIVE OFFlCER I CERTIFY UNDER PENALTY OF LAW TNAT I HAVE PERSONILLLY E%AMINED ANO TELEPHONE DATE <br /> AM FAMRIAR WITH THE INFO PMATION 9U9MITTED HEREIN; AND BASED ON - i <br />' <br />f MY INQUIRY OF TH09E IN DINOUAL9 IMMEDIATELY RESPY/NSIALE FOII ~ j _ <br />~ <br />1 . I, i T ~ , r ~' ~` F 2 <br />I O9TNNING THE INFORMATION , 16El1EVE THE 9U9MITTED INFORMATION 19 - / ~ j;~ ~ <br />~ <br /> <br />/ <br />LL TRUE, ACCURATE ANO COM <br />SIGNIFICANT PFNKTE9 FOR RETE. 1 AM AWME TNAT THERE NIE <br />SVBMITTINO FALSE INFORMATION <br />INCLUDING / ! <br />j /I'~ .I <br />^ <br />I <br />' <br />i , <br />T <br />E <br />O ~ ! <br />2 r <br />-, ~ VL j , r <br />l <br />d THE POSSI6IUTY OF RNE AND I MPNSONMEN <br />, 9 <br />E 19 U.9.C. E 1001 AN <br />7] 610NANRE OF PRINCIPAL EXECUTNE - i 1 <br />' / ~ / <br /> U.9.C. f 1]la. 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