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<br />Form Approve
<br />M AMR TNo. 2040-0004
<br />Explre[ 9.30.91
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<br />ACILHY YEAR MO DAY ~ YEAR MO DAY ) _
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<br />NAY[RITL! PRINCIPAL [%[CVTIV[ OFFICER I cERMr uND[R IENIILTY OF LAw THAT I NAV[ PEn+ENALLr [YAM1N[D
<br />AND AM FAMILIAR MTII THE RIfd1MATION SURMITTEO NEREM AND eASEO ~ ,. T[L[PNON!
<br />^ ~ ~ ~ ' D A T E
<br />J) ON MY INOI1Rlr OF THOrE 1NDV1WLL5 IAWEdwTELY R[SPONr1elE iOR
<br />OHINNWG THE Iryf011Ml1TgY. 1 BELIEVE TN[ weAlrt]ED INFORMATION
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<br />'~ '""` A"~R.,E ^~° COMRAE I AM ,YY.RE TWIT THERE 1.R[ SIG
<br />MIFICAMT PEMALTI[S FOR SUBMITTING FALSE INFpIMAT1pN IryL
<br />UO1NG
<br />HSEa & LAND MANAGER
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<br />970"8244451 ~ 5 ~7
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<br />- THE pOSSldLrtr OF FNE AND IMPRF,spNMENT 5[[ IB USC f 1001 AND
<br />]]uSC r 1]19 IRrMIn. •Mrr IArr mmin w Mrldr hn.. y m r14mr 'gIONATURE OF PRINCIPAL E%ECUTIYE
<br />TYPED OR PRINTED •b ~~•'+,+rw,R rmpnvMm.nr ,y A.t,rrn EmnneA.,ndA.ra..r OFFICER OR AUTHORIZED AGENT NUMBlR YEAR MO ~ DAY
<br />OMMLNT AND QPLANATION OF ANY VIOLATIONS IRrJrrcwre aY ,TlRrhmenlE here)
<br />SETTLEABLE SOLIDS LIMIT APPLIES ONLY IP <= 10-YR, 24-HR PRECIP EVENT IS CLAIhF.D. IP CLAIM APP ROYF.D 9Y
<br />G1CD, TSS f. IRON I.IHITS PILL NOT BE APPLIED TO REPORTED MP.ASUAEMENTS--SEE. I.B.lA, PG 4 AND I.D.1D, FG F,
<br />W. • (REPLACES ERA FowM r-Be rNICN MAY nor BE us[o.l Pwoe of
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