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PERMIT'TEE NAME/ADDRESS pn<heB Fa<u;ry Na,,,,a-ordro„ /og~,e„q
<br />NAME F1CBtT4IbE FF+CCFSSI`.i, LLC
<br />ADDRESSp F~ [ L k C I h E
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<br />NATONAL POLLUTAM DISCHARGE ELIMINATION SYSTEM MPDES) FOmI Approved.
<br />DISC~HA/6 GE MONITORING REPORT (OMR~9 a OMB No. 2040-0004
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<br />.'* I ~, C '. Approval expires OS31-98
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<br /> NAME/TITLE PRINCIPAL EXECUTIVE OFFICEfl I CERTIFY UNDER PENALTY OF L
<br />AM FAMILIAR WITH THE
<br />F AW THAT I HAVE PERSO NALLY E%AMINED AND TELEPHONE DATE
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<br />INQUIRY OF THOSE INDNIOUAL
<br />R ATION SUBMITTED HEREIN; AND BASED ON MY
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<br />SEE 18 U.S.C. 4 1001 AND 33 U.S.C. .
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<br />COMMENTS AND EXPLANATION OF ANY VIOLATIONS (Reference ell attachments here)
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