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<br />ADDRESSA0AD5IbE MI!ir., !; t; S FORTIES
<br />P.O. DUX 1430
<br />PALlSACe CC. b1S2b
<br />FACILITY
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<br />DISCHMOE NUMBER
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<br />NAME/TITLE PRINCIPAL EXECUTNE OFFICER I CERTIFY UNDER PENALTY OF LAW THAT I HAVE PERSONALLY E%AMINED MD
<br />AM FMIILIM WITH THE INFORMATION eURMITTED HERON; MD BASED ON TELEPHONE DATE
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<br />TYPED OR PRINTED U.S.C. 1 131 e. rPMWW1 YI/.I fMM ,YMes NI.Y ickW lYMa uP ro f 10,000
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<br />COMMENTS AND EXPLANATION OF ANY VIOLATIONS LRe/erence ell slleehments here)
<br />adTTLEAdLE SOLIDS LIRIT APPLIES ON L! IF ~=lUXH/24MH PRECIPITATION EYLIT IS CLAICEC. PERRITTEE f4A5
<br />uUiiUEN OP PROOF YHEN REQUESTING RELIEF FRUH SETTLEAUL4 SOLIDS PFIiSAAY LI!fITATI015.
<br />EPA Form 3320-1 108-95) Previous editions mey be used. (REPLACES EPA FORM TAO WNICH MAY NOT BE USED.) C O4 9 S / 9 0 C c 2 3-12 S 6 PAGE 1 OF
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