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PERMITTER NAME/ADDREas (1nNNde I - NATIO AL POLLUTANT DISCHARGE ELIMINATION SYSTEM (NPDES) Form Approved
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<br /> CGI ` O 2040 OMB No.17.19) .I
<br /> _--_—-- _ . F F 1 i-i A L a Approval esplraa 12-31-V
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<br /> NAME/TITLE PRINCIPAL EXECUTIVE OFFICER 9 CERTIFY YUNDER PENALTY rOF LAW THAT I>HAVE PERSONALLY EXAMINED J„• - 1 - - TELEPHONE D A
<br /> AND AM FAMILIAR WITH THE INFORMATION SUBMITTED HEREIN AND BASED F _ - `' T E_
<br /> % ON MY INQUIRY OF THOSE INDIVIDUALS IMMEDIATELY RESPONSIBLE FOR S - j - _ \"� }•
<br /> OBTAINMG THC INFORMATON 1 BE4EVE THE SUBMITTED INFORMATION - _ J �f I+ ,�1 L +1 k
<br /> Lf/�V• �Jl // l// /C 15 TRUE ACCURATE AND COMPLETE 1 AM AWARE THAT THERE APE SIG �� ' 1 _ L-?
<br /> NIFICANT PENALTIES FOR SUBMITTINO FALSE INFORMATION, INCLUGNG ] - '- Y
<br /> �' TNf POSSIBILITY OF FINE AND IMPRISONMENT SEE IS U5C 1 1001 AND ( ATURi OF,PRINCIPAL EXECUTIVE
<br /> /. 33 USC 1 131E /Prnalw-a under thrr Earules nr nrrude lmra up rn$f0,1[F1 ar I
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<br /> OFFICER OR;AUYHORI2ED AOENT� •.
<br /> COMMENT AND EXPLANATION OF ANY VIOLATIONS (Reference ari a1luehment3 here) `. i -
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<br /> EPA Form 3320•I (Rev. 10-79)PREVIOUS EDITION TO BE USED (REPLACED EPA FORM a11p WHICH MAY NOT■E USED.) P GE OF
<br /> UNTIL SUPPLY 19 EXHAUSTED UIOU04/ 01 OJ(1 J-4-110
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