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PERMITTEE HAMEIADO( O.r44 F..nrry Naw/L«mrm dOrpr..0
<br />NAME (•OI,OSIYI. ,:GAL COMPANY L. P.
<br />ADDRESS COLU'a Y!) 111`1 F;
<br />5731 S7.'ATF. f1IGIINAY 13
<br />Mtt;K1:H CO U1641
<br />FACILITY
<br />LOCATION
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<br />NAME/TITLE PRINCIPAL E%ECUTIVE OFFICER 1 CERTIFY UNDEA PENALTY OF
<br />AM FAMILIM WITH THE INFO UW 7HA71 HAVE PERSONALLY EXAMINED MD
<br />AMATION SUBMITTED HEREIN; MO BASED ON TELEPHONE DATE
<br /> My INQUIRY Of THOSE INDIVIDUALS IMMEDIATELY flE5PON51BLE FOR
<br /> OBTNNIHO THE INFORMATION, I BELIEVE THE SUBMITTED INFOAMATION 15 '
<br /> TRUE, ACCUMTE AND COMRETE. I AM AWME THAT THEflF ME
<br />INCLWING
<br />51GNIFICMT PENALTIES FOR BUBMITTINO FALSE INF011MATION
<br />~' 1~f ~
<br />1.1 ,
<br />THE POSSIBIDTY OF FlNE MD IMPIIISONMENT. SEE IB U.S.C. E 1001 MD ]]
<br />An]RE OF %IINCIPAL EXECl7TIVE r] J
<br />`{ g21~~ Ib00 qQj .~
<br /> V.S.C. 1 I IIB. lP,rWN,1 W,r MM ,6M„ re•Y ~~• f a uA ro f 10,000 AREA
<br />TYPED OR PRINTED .n0 or muinun inplon..er or brw„n smonrAa •.M6 v..ra.l FFICER OR AUTHORIZED AGENT CODE NUMBER YEAR MO DAY
<br />COMMENTS AND E%PLAN AI ION OF ANY VIOLATIONS IRe/ersnce ell errecnmenls Oere/
<br />SF;'TfLEA9LF SOLD; LIMIT 9pPLIF.S ONLY 1F <= 10-YR, 24-(IR PRF.CIP P.YP,NT IS CLATMr'D. TF CLAIM APPROVED DY
<br />k~)CU, TS:.i E TR;Yi L7MIT5 RILL NOT RP, APPLIP.D TO REPOHTF,D ME9SUitRMTiNTS--SEF I,Fl,lA, PG U AN9 T. R. 1D, PG 6.
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<br />EPA Form 3320-1 IDS-951 Previous s Ilione mey be used. (REPLACES EPA FORM T-00 WHICH MAY NOT BE USED.1 ~,,,, ~ ~ ,,, „ „~., ., ~, PAGE - OF
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