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<br />PERMIT'fEE NAME/ADDRESS (LWdr F~cdiryNO,u/Locmlm lJD~mq NATIONK POLLUTANT?~ C ~l' INATON SYSTEM /NP~ES) Form Approved.
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<br />ADDRESS :•,U'+cFr CANYON ;JjaF: _ COOU408 0 (SD;- =r) Approvala~p~r~r}305.31-96
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<br />NAMERITLE PRIHGpA1: EXECUTNE OFFlCER (CERTIFY VNDEAPENKTy TINAVE PEfl50NKLY EAAMIN AND IELENMONt VFIE
<br />AM FAMIDAR WIit1~THE 5 M1TT(D HERfMI; ~1D 8A5 ON
<br />A ~I ~ MT INONM1Y Of TNOS K$ IMMEgAiELY IIESPON9lI.E fpR i
<br />ks OITAfNMG TME-M1 EYE THEE SUlI~~1TT~j~ IAFOflM~Li~ON IS
<br />TRUE, ACCUMiE ANY ~ 1'AM'~ AWARE 7NAY TN E(IE Al1E
<br />~~~~ SIGNIFICANT PENKTI 1TY/G FK9E IN OAMATION, INCl1A71N0 y3, L{4~945 p1 ~ Z`-{
<br />THE POSS16R1TY OF RME RI M[MT. SEE to V.S.C. S t001 AND 7] OIONATUIIE OF P111NCt-AL EXECUTNE
<br />u.s.c. s t31~. rAA,.lw. w.aaNr Irrr r*cwn. Aw. w a ! rdlao0 AR A NUMBER YEAR MO DAY
<br />TYPED OR PRMITED ..snmarinun MFr4amNnr Mrw«n emennu rM6 y.YAI OFFICER OR AI/THORI2ED AQENi CODE
<br />COMMENTS AND EXPLANATION OF ANY VIOLATIONS IRder~nce N/ eTEechmenra Aeg1
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