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PERMITTEE NAME/ADDRESS (IrrLb FrWryN~./Laranm //Ol~frrar)
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<br />NATIONAL POLLUTMT DISCHMGE ELIMINATION SYSTEM INPOESI
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<br />PERMIT NUMBER DISCHMGE NUMBER
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<br />YEAR MO DAY YEAR MO DAV
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<br />Form Approved.
<br />.' [i U T I J K C R [1 G; F P OMB No: 2040-0004 ~
<br />(~ I1 2 a ,+ .~ ~ Approve) sxpuea 05-31-98
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<br />NAMERITLE PRINCIPAL ExECUTIVE OFFICER I ceflrl FY UNDER PENUTr of LAW THAT I NAVE PERSONALLY ExAMINED AND TELEPHONE DATE
<br /> AM FA MILIM WITH THE INFORMATION SUBMITTED HEREIN; MO BASED ON ~_
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<br />MY INQUIRY OF THOSE INDIVIDUALS IMMEDIATELY flESPON5IBLE FOR
<br />OBTNNINO THE INFORMATION, I BELIEVE THE SUBMITTED INFORMATION IS \
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<br />TYPED OR PRINTED AM OrmMirivn brp.'s+wr+r olbn.wnemmw.ns6y.ra/ OFFlCER OR AUTHORIZED AGENT CODE NUMBER YEAR MO DAV
<br />COMMENTS AND EXPLANATION OF ANY VIOLATIONS /Reference e// attsc/lmenh Aerel
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<br />EPA Fam 3320.1 108-951 Previous editions mey be used. (REPLACES FPA FORM T40 WHICH MAY NOT BE USED.1 ~.) J 7 / .1 / ,/ Ir L '1- 1 „ r L PAGE t OF
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