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<br />t 15. Is this operation located within one mile of a landfill, or any mine or <br /> mill tailings? _YES ENO <br />' If YES, please show location of the landfill or tailings on the location <br /> map (7) or general sketch map (8). <br /> 16. Will flocculants (nettling agents or chemical additives) be used to <br />' treat water prior to discharge? YES g NO <br /> If YES, specify chemical used. <br />' 17. Estimated life of the activity from which the discharge(s) identified in <br /> C9) originate. 5 Years. <br /> 18. I certify under penalty of law that I have personally ezamined and am <br />' familiar with the information submitted in this application and all <br /> attachments and that, based oa 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 pe ltiea for submitting false information, including <br /> the possibility of ins or imprisonment. <br />1 1 <br /> 1.) <br /> A. SIGNATURE OF OWNER s B. DATE SIGNED <br />t ~ Ken Nesbitt <br /> C. NAME PRINTED D. TITLE <br />1 2.) <br /> S ATURE OF OPERATOR DATE S GNED <br />' •C. NAME (PRINTED) D. TITLE <br />' 19. 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 />re:~ponaibile 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 />thf: possibility of fine and imprisonment. <br />t 1.) _ <br />A. SIGNATURE OF OWNER(s) B. DATE SIGNED <br />' C. NAME (PRINTED) D. TITLE <br />' 2.) <br />A. SIGNATURE OF OPERATOR B. DATE SIGNED <br />' C. NAIgE (PRINTED) D. TITLE <br />1 <br />