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<br />NAME/TITLE P I IP OFFICER I CERTFY UNDER PENALTY of LAW THAI I HAVE PERSOWILLY E%AMINED .. ~ I TELEPHONE ' _ ~. DATE i
<br /> AND AM FAMILWR WITH THE INFORMATION SUBMITTED HEREIN: 4ND BASED ,,
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<br />HSE~ & LAND MANAGER:; •? CN MY INOIARY OF TIgSE WpVIDUAl9 MMEDIATELY RED VgBLE FOR
<br />TRUE.NI~CURATEFOARND TCOMPLETEEVE AME AWARE~ETHATFOTHERE ARIE I
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<br />THE POSSIBILrtY OF FINE AHD IMPRISONMENT. SEE IB U.SC. 1 1001 AND
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<br />SIGNATURE OF INCIPAL EXECUTIVE
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<br />33 USC 1 1]19. (
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<br />TYPED OR PRINTED f 10000 end or wsimum imprispNnenl o! herreen b months end 5 yeah) OFFICER OR AUTHORIZED AGENT C NUMBER YEAR MO DAY
<br />COMMENT AND EXPLANATON OF ANY VIOLATIONS (Xe(erence ell attachmenlb here) - - - .' ~, y _ I
<br />SETTLEABLE SOLIDS LIMIT APPLIES ONLT IF'<~ 10-YA. 2Y-NR PRECIP EYENT IS•CLAIMED6 IFICLAIM APPAOYED'B~ f''
<br />f+yCG, TSS E IRON LIMITS wI1L NOT BE APPLIED TO AEPORTED NEASUREl1ENT3--SEE I.B61Aa PG 4 AND.I6f3.1Da PG fi.'
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<br />EPA Form 3320-. 9-88) P(891016 editions may be IseU. (REPLACES EPA FORMS" W HICK MAY NOT BE USED) '~ OOO 1 Z 19 31109 ~ 13 31 '
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