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<br />NATIONAL POLLUTANT DISCHARGE ELIMINATION SYSTEM (NPDES)
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<br />(2P21) R2-231 84251 Rs2T1 RB-291 (JOJf)
<br />Fonn Approved.
<br />„ ~ , „ _ OMB No. 2040-0004
<br />Approval expires 0531-98
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<br />NAME/TITLE PRINCIPAL EXECUTIVE OFFICER I CERTI
<br />AM FAM FY UNDER PENALTY OF
<br />ILIAR WITH THE INFORM LAW THAT I HAVE PERSO
<br />ATION SUBMITTED HER NALLY ET(AMINED ANO TELEPHONE
<br />EIN
<br />AND GASED ON MY DATE
<br /> INQUIRY OF THOSE INDIVIDUAL S IMMEDIATELY RESPON ;
<br />SIBLE FOR OBTAINING
<br />Rlcha rd ~~1I I I8 THE INFORMATION, I BELIEV E THE SUBMITTED IN FORMATION IS TRUE, ~.~
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<br />environmental P~inna~~ r
<br />ACCURATE AND COMPLETE.
<br />1 AM AWARE THAT TH
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<br />~ 7O-$7O'2712 5 2G $9
<br /> PENALTIES FOR SUBMITTIN
<br />POSSIBILnY OF FINE AND IMPR ING THE
<br />G FALSE INFORMATION,
<br />C
<br />ISONMENT. SEE [a U.S.C. 4 1001 AND 33 U S.C.
<br />SIGNATURE OF PRINCIPAL EXECUTIVE
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<br />NUMBER
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<br />MO
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<br />COMMENTS AND EXPLANATION OF ANY VIOLATIONS (Relerence all effachmenfs here)
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