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<br />L. PERMITTEE NAME/ADDRESS O+drd.FrJlry Ner/(.rerlen UDl~nnQ
<br />,.NAME BASIN RB5OURC65, INC. ,~ FL~R
<br />ADDRESS GOLDEN , E:'A6LE RIAEH'~.L
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<br />~YL ~- 'PERMIT NUMBER - ~ ~ - - - ~- DISCMMGE NUMBER "
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<br />YEAR MO DAV - YEAR MO DAV
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<br />114111 l1I-131 !14151 - !76 1 /18-791 !3431)
<br />- Form Approved.
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<br />NAME/SRLE PRINCIPAL EXECUTNE OFFICER T CERTIFY UNDER PENALTY OFi AW THAT I HAVE PERSONKLY EXAMINED MD TELEPHONE DATE
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<br /> AM FAMILIM WITH THE INFO RMATION 6UBMITED HEREIN; MD BASED ON
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<br />t G MY INQUIRY OF THOBE INDINDUALB IMMEDIATELY REBPON9BLE FOR ~
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<br /> TNNING THE INFORMATION, I BELIEVE THE SUBMITTED INFORMATION IS -~//
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<br /> TRUE, ACCUMTE MD {OMPLETE. I AM AWME THAT THERE ME
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<br />1 M gIONATURE OF PRINGPAL EXECUTNE :
<br /> U.B.C. E I ]t s. ~lMreMr I/14// eMM enema rnrY MNitr lMMA W ro t 10,000 AREA
<br />TYPED OR PRINTED erlsrmuirwninprlonwlt a/rnrrNl6mpilAr ens 6Te~al OFFICER OR AUTHORIZED AGENT CODE NUMBER YEAR - MO DAV
<br />COMMENTS AND EXPLANATION OF ANV VIOLATIONS IRSfersncs s//etteehmenF] hers/
<br />S$LIYLB-BLE SOLIDS LIHIT WANED FOR 10-YR, 24-HR PRECIP 6YEN1 SOElfFCS 7C BURGFN CF PROOF REQUIREB6NT5 IN
<br />gi,RT I.B.leD, P. 6. STORLrATSR 14AYAGEBBYT PL-r DDE 1-39.98
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