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<br />MINOR Form Approved
<br />(SUER NW) M®~1 R'[No. 2040.0004
<br />P. - FINAL EXplres 9.30-91
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<br />MONITORING PERIOD
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<br />LOCATIOM FROM ~ TO 1 #aa
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<br />NAM[/TITLE PRINCIPAL [XK`UTIVE OFFICER I C[RRFr uMDE11 PEMALTr OF LAM THAT I HAVE PERSONALIV [AwMIN[O
<br />AMD AN FIIMILIwR MITN THE INFORMATIOII SUBMITTED NERfIN AND BASED
<br />' TELlPNONE D A T E
<br />«~ Mr INOllwr OF TNOSE MDVIplALS IMYEdATELY MESPOMrML[ FDR
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<br />OBTAINMG THE INFOiMATb.V I BELIEV[ THE SUBMITTED INFDRMATIDII
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<br />KINSON
<br />IS TRITE. 11000RATE AND COMRETE I AM AWARE THAT TNERF AMC SIG
<br />INCLUgNG
<br />- ~'°~•~' PENI,LTIES Fow suw,RT,NC FALSE IM(GRMATIDN
<br />HSE~ SI LAND MANA
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<br />GER
<br />THE VOSSI&LRr OF FIN[ wnD IMPRFiOMMENT K[ IB USG 1 1001 AND
<br />33uSC 11319 IPeMIIMr un/n MrV +bluln III nrlu/r /Yln y /u lfI!M/I SIGNATURE OF P INCIPAL E%ECUTIVE
<br />TYPED Op PRINTED •Id u.llM+lmwl llnOnHn AI.III.J MIUwn EllwnlA. rnd.ilnrll OFFICER OR AUTHORIZED ApENT NUMBER ~~ YEAR MO DA
<br />COMMENT AND EXPLANATION OF ANT VIOLATION6 IRr/rrrwrr Rll ulluc'hlnenli heir)
<br />SETTLEABLE SOLIDS LIMIT APPLIES ONLY IF <= 10-YR, 24-HF. PRECIP EVENT IS CLAIMED.' IF CLAIM APPROVED' BY
<br />~'OCD, TSS B IRON LIMITS HILL NOT AE APPLIED TO REPORTED MEASUREMENTS--SEE 7.B.lA, PG 4 AND I.B.1D, PG 61
<br />E I BFI- ~ IR[-LAOEf [PA PORM T-10 WNICN NAY NOT f[ Uf[D.) PAD[ OF
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