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PERMITTEE NAME/ADDRESS (Include Fxiliry Nmnr/Gaeanon ijDigerenq
<br />NAME
<br />t?LNSEC, INC.
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<br />:•.'FIN: J. E. STCV'L. CCNSULTTNG FNC_
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<br />PERMIT NUMBER Disc
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<br />i (NVOes) Form Approved. ,
<br />OM8 No. 2040-0004
<br />') C I 6 C F Approval expires OS-31-98
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<br />NAME/TITLE PRINCIPAL E%ECUTNE OFFICER I CERnFV UNDER PENALTY OF L
<br />AM FAMILIAR WRH THE INFORM AW.THAT I HAVE PERSONALLY EXAMINED ANO
<br />ATION SUBMfTTED HEREIN
<br />AND BASED ON MY TELEPHONE DATE
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<br />J INQUIRY OF THOSE INDIVIDUAL
<br />THE INFORMATION
<br />I BELIEV ;
<br />S IMMEDIATELY RESPONSIBLE FOR OBTAINING
<br />E THE SUBMITTED INFORMATION IS TRUE
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<br />ACCUMTE AND COMPLETE ,
<br />I AM AWARE THAT THERE ARE SIGNIFICANT
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<br />PENALTIES FOR SUBMITTING FALSE INFORMATION
<br />INCWDING THE ~
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<br />Y L'L I UEI~ ~
<br />POSSIBILITY OF FlNE AND IMPRI ,
<br />SONMEM. SEE to U.S.C. 41001 AND 33 U.S.C. y
<br />SIGNATURE OF PRINCIPAL El(ECUTIVE J,,// ~y~
<br />L7S-770 ~
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<br />TYPED OR PRINTED mum m~ja~ilmem of ~MS~e
<br />p n 6maont u~entl5utle lures up ro 510.000 entl a
<br />ysvs.) OFFICER OR AUTHORIZED AGENT
<br />NUMBER
<br />YEAR
<br />MO
<br />DAY
<br />GOMMhNTS ANO EXPLANATION OF ANY VIOLATIONS (Relerence a/l attachments here)
<br />~~TTLFAELE SCIIDS LIMIT TILL Fi wAIYECI F'CH J1C-YF, 24-H} FFECIF EYF!i1-SEe I.A.2, iG IY, FCF }E~LIFEfElT=.
<br />GE~:hLY SAt.PLING Ih:TFLCTZChS-I.C.9, pC IX. 30 CAI AVG IS t!ICI:EST MCNThLY AYt; ClF]AG FtF]CL FEEC67EC.
<br />EPA Form 33261 (O$-95) Previous editions may not be used.
<br />(REPLACES EPA FORM T-40 WHICH MAY NOT BE USED.)
<br />CCC59/99C11:-llC~
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