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PERMITTEE NAME/ADDRESS pnclude Faailiry NumdLomnon ifD~erenr)
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<br />NATIONAL POLLUTANT DISCHARGE ELIMINATION5Y$t):M (NPDES)
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<br />Form Approved. ~
<br />OMB No. 2040-0004 ~
<br />" i '• C (+ Approval expires 05,31-98 ,
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<br />NAME(fITLE PRINCIPAL EXECUTIVE OFFICER I CERTIFY UNDER PENALTY OF LAW THAT I HAVE PERSONALLY E7(AMINED AND
<br />AM FAMILIAR WITH THE INFORMATION SUBMITTED HEREIN: AND BASED ON MY TELEPHONE DATE
<br />INQUIRY OF THOSE INDIVIDUALS IMMEDIATELY RESPONSIBLE FOR OBTAINING
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