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PERMITTEE, NL+LAE//~O,pl~$S p,.rVlt~ xMrws/Loeo~rlon iJD(QGren,)
<br />NAME ._.L~~+r_... f", , ~~,Y-4~K :~i~i~,.
<br />ADDRESS ~gl~: #{:,.`'::~ ', f~a~'+t~~'~i~4 1 ~~)`ti
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<br />Form Approved.
<br />NATIONAL POLLUTANT OISCHAROE ELIMINATION SYSTEM //NPDESI _ OMB No. 2040-0004
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<br />E PRINCIPAL EXECUTIVE OFFICER ' etr'uy ° er pem q o hw that mh doeumem and dl attachmetau were TELEPHONE DATE
<br />NAME/TITL prepared under my direction or superNslon In tieeordance with ~ syriem desiLncd
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<br />- ~ r ~ tylV~,.. to auure that qualtRed personnel P~H7 Lather and e~aluale the Infonnulion
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<br /> or those penoro directly roporolbk for pthednL the Information, the Information ~
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<br /> submitted b, to the best of my knowkdLe end belief, true, amrnte, and complete.
<br />1 am aware that there arc sI
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<br />pED OR PRINTED IndudlnL the posiblilty of Bne and Imprisonment for knorrlnL .Ioiatlorrs. OFFICER OR AVTHORIZED AGENT CODE NUMBER YEAR MO DAY
<br />Cp1~A1~1ENTS ND EXPLANATION OF ANYvIOLATIONS Rtr~~rt~nc~ s/~ ~ achm~ htr,~,,t~,, ,~ w E_ I ~ .~ ~~ t ,., ~, .~ ti+.- a ,. ~ `.•, j. .~ ~ .~,~
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<br />~.. ~.~..: 1' Q. ,11,5'1' at,~ 4, ' ~ ~ PAGE bF
<br />EPA Form 3320-1 (Rev. 3/99) Previous editions maybe used. p8T'I fbrlll.
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