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lj <br />16. <br />17 <br />18 <br />1.) <br />2.) <br />19. <br />1.) <br /> <br /> <br />Is this ope.ratior. located w.i[hin nno ^_iFr oS ;~ .Inncifill, or any mine or <br />mill tailings? _YES ~NO <br />If YES, please show location of rile landfill or tailings on the location <br />map (7) or general sketch map (8). <br />Wi11 flocculants (settling agents or chemical additives) be used to <br />treat water prior to discharge? _YES ~NO <br />If YES, specify chemical used. <br />Estimated life of the activity from which the discharge(s) identified in <br />(9) originate. _ Years. <br />I certify under penalty of law that I have personally examined and am <br />familiar with the information submitted in this application and all <br />a[tacltments and that, based on my inquiry of those individuals <br />immediately responsible for obtaining the information, I believe that <br />the information is true, accurate and complete. I am aware that there <br />are significant penalties for submitting false information, including <br />the possibility of fine or im risonment. ~~ ~ ~2 (-(~~,r o-f ca~I2~ <br />-Elam owner a rtz~ <br />5 ~acllec~ . Exh,6,1 F, <br />A. SIGNATURE OF OWN ER(s) B. DATE SIGNED <br />C. NAME <br />T <br />D. T <br />I certify under penalty of law that I am familiar with the conditions at <br />the site and that, based on my inquiry of those individuals immediately <br />responsibile for the site, operating conditions have not changed from <br />that which is identified in our current certification and permit. I <br />therefore request renewal of our certificatin. I am aware that there <br />are significant penalties for submitting false information, including <br />the possibility of fine and imprisonment.r- <br />~Set a~r~te6no%~~so~~tEfri~ rGXLl,~6.t' f~ ~.a~~/ ~`/ /9P <br />A. S GNATURE OF OWPlER{s) l B. DATE SIGNED <br />G/cs l c Sco <br />C. NAME ( INTED) <br />A. SIGNATURE OF OPEF <br />C. NA,`tE (PRS<`TED <br />D. `TITLE p <br />B. DA E S GNED <br />~O ~e ~afi~ <br />D. TITLE <br />