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<br />NAMl RITLE PRINCIPAL EXECUTIVE OFPIClR I CERTIFY uNDEn REfutiY a uw THAT I NAVE P[IF,.ONALIV EXAMINED
<br />AND AM FAMILIAR MTM THE INFORMATION SUBMITTED N[REIM AMD d15[D
<br />- TELEPHONE D A T E
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<br />S~N DN MT Rgl1IRT OF THOSE INDIVIDUALS IMMEtlATELY IRS.OMSiBLC FOR - ~
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<br />HSED & LAND MANAGER ~
<br />~ ORFAMnIG THE INFORMATIOa I BELIEVE THE SIIBWTTEO INFORMATON
<br />IS TRUE ACCURATE AND CCYPLET[ I AM .WAR[ THAT TNERF ARE SIG
<br />NIFICANT FEN,LTIES FDR SD91DTIN( F,LSE INFORM.T[MI
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<br />THE POSSIBILrtr OF FmE AND IMPR5ONMENT SEE IB uSC ~\ IOOI AND
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<br />up m l14r•b IONATURE OF PRINCIPAL EXECUTIVE L -
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<br />TTPEDORPRINTED ,
<br />e.d ur mA.rmwr rmpnrnmrrN ~d Mru.rn0m.mtA.And.:.Nr.r OFFICER OR AUTHORIZED AGENT NUMBER YEAR MO DAY
<br />COMMENT AND [][PLANATION OP ANY VIOLATIONS (ReJerrnre uE uffuL'hrnenfa here)
<br />5~'TTLEABLE SOLIDS LIMIT APPLIES ONL! IP C= 10-TR, 24-NR PRECIP EVENT IS CLAIMED. IF CLAIM APPROVED BT
<br />M(ICD, T55 E IRON LIMITS MILL NOR BE APPLIF,D TO REPORTED MEASUREMEIITS--SEE I.B.lA, PG 4 AND I. B. 1D, PC 6.
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