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PERYITTEE NAMEIA~ iB llnrlade
<br />Faaliry NOmr/Lororio /enU
<br />NAME-•y ~ 111.!! 41. i~ ~JillY- - - - - - -
<br />ADDRESS.:,JJILMY'1 >lluE.~-----------
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<br />FACILITY ---___--____-----
<br />LOCATION ~ _
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<br />NATIONAL POLLUTA ^HAPGE ELIMINAIIUN SYSTEM I/YYUGJ/ „
<br />DISCHAR~ )NITORINO REPORT (OMR/ ( Y0.2tMD-0001
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<br />YEAR MO DAY YEAR MO DAY'
<br />FROM 11 TO ,; 1 f; C~h +) f: (`, lj t1 ji Fi Y) !1 i) F A T ~
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<br />NAME?ITLE PRINCIPAL EXECUTIVE OFFICER '• I CERTIFY.UNDER PENALTY OF UW TMAT I HAVE P ERSONALLY E XAMINED ~,
<br />l TELEPHONE DATE~
<br />-
<br />AND AM FAMILIAR WITH THE INFORMATION SUBMITTE D HEREIN; AN D BASED - ~./
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<br />~ ., ON MY INQUIRY OF THOSE INDIVIDUALS IMMEDIATE LY RESPONS IBLE FOR ,/ ,
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<br />H. (i. ATKIN SON'. ~ n G OBTAINING THE INFORMATION. I BELIEVE THE SUB
<br />~ IS TRUE, ACCURATE AND COMPLETE. I AM AWARE MITTED INFO
<br />THAT THERE RMATION
<br />ARE BIG- '
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<br />VP LANI)~EN~IRONMY:NTAL AFFAIRS ,
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<br />THE POSSIBILITY OF FINE AND IMPRISONMENT, SEE 18 U.S.C. J 1 SIGNATURE OF PRINCIPAL EXECUTIVE
<br />' ~ d7 U.S.C. ~1 1J1P. (Arnvlrla under rhe+e Hamra Tar Inrladr Jlne up to JIa,OJO
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<br />' TYPED OR PRINTED
<br />and or marlmum lmw4onmrnr oJdernxsn6 monlMand Jlavrzl OFFICER OR AUTHORIZED AGENT NUMBER YEAR MO ~ DAY
<br />COMMENT AND EXPLANATION OF ANY VIOLATIONS/ReJarenn: all anarnmertrJ nen/ 1
<br />1,r UIL o ,NF.ASE:--9FF' FJOTNU'CE: F/ IN Tlit: PE;i`fIT. SE:TTLEAELE SOLIDS 'r t. s; ?E/,t)18r:U 'GREY iF <= 1V-Yli, .)1-IUt
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