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REQUIREMENT: : ::::'ri.:.'::::..ri::::' . . . ::: ::.::..:.:.::.:::: r~;:•`.o. .::` .. '7RFk:..:~Y:G; ,..v. . ...... :: k:L{`.I~::AR "! ;/i. .: NAMERITLE PRINCIPAL EXECUTNE OFFICER 1 CERTIFY UNDER PENALTY OF lAW THAT I NAVE PERSONN.LY ExAMINED MD AM FAMIUM WITH THE INFORMATION SUBMITTED HEREIN MD B E ' TELEPHONE DATE /~ /~ f -+, ~ : / ~~; /~': ~'„ ; AS D ON MY INQUIRY OF THOSE INDIVIDUALS IMMEDIATELY RESPONSIBLE FOR OBTNNINO THE INFORMATION, I BELIEVE THE SUBMITTED INFORMATION IS .. I / ~~ I ' ^ TRUE, ACCUMTE MD COMPLETE. 1 AM AWME THAT THERE ME SIONIRCANT PENN.TIES FOR SUBMITTING FALSE INFORMATION INCLWINO ~ /.. ~ ,;~ ~ L ~ . {~ ' I' ~ I .! I 1 i ~ I t ~ , THE POSSIBILITY OF FNE MD IMPNSONMENT. SFE to U.S.C. 1 7001 MO 77 /.1i ~l~' . ' • ~ i ' ' ~ / ~ S C ! 1310 U fMWab uIM tlnr .hNe. Ie. Mch+1~ Mta ro t 0 00 SIONATUIIE Of PRINCIPAL EXECUTNE _ ' TYPED OR PRINTED . . . . yr l , 0 Y .rwwnl..h..lr inprlonwlr a/an.F.n e.emm.w6 Fnral OFFICER OR AllTNORIZED AGENT CO E NUMBER YEAR MO D V D A SBITLEA'.+Lt: .OLiG°_ LTA?': AP'eLIES i)dLY iC <=LJYk,2~ri: PaFC.iF ^VPji ..: ~LAI"i^. IF CLAI" ?P?~7t''D HY a~~D -~ ! ^+"r. •, NO? ;rl ~:, ~ Lrl:. . i ._ 11.1. `~t. APPLI: ?') f~f?~JF. ~ I~:I. •: -n :NC ~-'°" EA ~, .3'. .. ..c I.a.:, PG q~ F•~:: •:Ll , ::i'•S nr pD.~.:;• „ .,. ,TI c _T r r r, rT~t• K r-Ta _r n' 7 - 7 EPA aim 3320• 108.8 1 Previous editions mey be uead. - (REPLACES EPA FORM T-0O WNICN MAY NOT BE USED.( ~~ I I I / I ~) ,C ~ i; _ I r .~ i PAGE IOF