ࡱ> ^`]3 bjbjKK Ka)w)wl"""""""6 80 L| 6m@TTTT\0$W w u""@"""""TT'"X"T"T"~""T `6 z =0m!!66""""Please complete all sections. If one person serves multiple functions, please repeat this information in each section. PERMIT NUMBER:  FORMTEXT       FILLIN "Permit Number" \* MERGEFORMAT  DATE:  FORMTEXT       PERMITTED FACILITY:  FORMTEXT       COUNTY:  FORMTEXT        OFFICIAL PERMIT CONTACT: (The permit signatory authority, e.g. responsible corporate officer, principle executive officer or ranking elected official) Official Contact:  FORMTEXT       Title or Position:  FORMTEXT      Mailing Address:  FORMTEXT      City:  FORMTEXT      State:  FORMTEXT      Zip:  FORMTEXT      Phone number(s):  FORMTEXT      E-mail:  FORMTEXT       PERMIT BILLING ADDRESS (where invoices should be sent): Billing Contact:  FORMTEXT      Title or Position:  FORMTEXT      Mailing Address:  FORMTEXT      City:  FORMTEXT      State:  FORMTEXT      Zip:  FORMTEXT      Phone number(s):  FORMTEXT      E-mail:  FORMTEXT       FACILITY LOCATION (actual location of permit site and local contact for site activity): Facility Location Contact:  FORMTEXT      Title or Position:  FORMTEXT      Facility Location (physical street address):  FORMTEXT      City:  FORMTEXT      State:  FORMTEXT      Zip:  FORMTEXT      Phone number(s):  FORMTEXT      E-mail:  FORMTEXT       Alternate Contact (if desired):  FORMTEXT      Title or Position:  FORMTEXT      Mailing Address:  FORMTEXT      City:  FORMTEXT      State:  FORMTEXT      Zip:  FORMTEXT      Phone number(s):  FORMTEXT      E-mail:  FORMTEXT       FACILITY REPORTING (Discharge Monitoring Report (DMR) or other reporting): Cognizant Official authorized for permit reporting:  FORMTEXT      Title or Position:  FORMTEXT      Mailing Address:  FORMTEXT      City:  FORMTEXT      State:  FORMTEXT      Zip:  FORMTEXT      Phone number(s):  FORMTEXT      E-mail:  FORMTEXT      Fax number for reporting:  FORMTEXT      Does the facility have interest in starting electronic DMR reporting? Yes No      Tennessee Department of Environment and Conservation Division of Water Pollution Control 401 Church Street, 6th Floor L & C Annex Nashville, TN 37243-1534 Phone:(615) 532-0625 PERMIT CONTACT INFORMATION CN-1090 (rev. 04-2007) RDAs 2352 AND 2366 *,.8< "&8:NPR\^`dҽɮ铢ע҇ɮxעk5CJ\aJmHnHujb5CJU\aJjCJUaJjv5CJU\aJj5CJU\aJjCJUaJmHnHujCJUaJjCJUaJCJaJ"j5CJU\aJmHnHu5CJ\aJjCJUaJmHnHu)`f 4$If $If^ L]^L;$x<$d%d&d'd-DM NOPQ]^a$p]p -  -B@B B D "$&0246XZnpr|~ܼ܈ܼ~tg~jCJUmHnHuj4CJUCJ jCJUj5CJU\j5CJUmHnHujL5CJU5CJj5CJUCJj5CJU\mHnHuj5CJU\ 5CJ\j5CJU\ 5CJ\CJOJQJaJCJaJ&46X $Ifx$$Ifl404-40-2 2 4 la       @ B V X Z d f h x z   : < P R T ^ ` b ӈׅڀtj5CJUCJaJCJj 5CJUj5CJU\mHnHuj5CJU\ 5CJ\j5CJU\ 5CJ\j 5CJU5CJCJCJj5CJUmHnHuj5CJUj5CJU-  @ h x ^XXXX$If$$Ifl4\4#&-4s ;0-2 2 4 la  : b GAAAA$If;$x<$d%d&d'd-DM NOPQ]^a${$$Ifl404-40-2 2 4 la   " , . 0 > @ T V X b d f p r տƵj@5CJUj5CJUjT5CJUjCJUmHnHujCJU jCJUCJjj5CJUCJj5CJUmHnHuj5CJUj5CJU5CJ1  0 > f p $Ifo$$Ifl405-50,4 lal  gaaaa$If$$Ifl4\5] $-5( 0,4 lal      F  " $ & 0 2 4 Z \ p r t ~ (*,68:HJ^`b÷ëßטڎuj 5CJUjCJUmHnHuj CJU jCJUj 5CJUj 5CJUj, 5CJU5CJCJaJ5CJ\aJCJCJCJj5CJUmHnHuj5CJUj5CJU.  4 Z PJJJJ$If;$x<$d%d&d'd-DM NOPQ]^a$r$$Ifl405-50,4 lal :Hpz@$Ifq$$Ifl420-- y 0,64 lal blnpz|"$&(*jl(*,8:޺ޫޟޓ jCJUj 5CJUjJ 5CJUj 5CJUCJj` 5CJUj 5CJUjt 5CJU5CJCJCJj5CJUj5CJUmHnHu7&e____$If$$Ifl4$\- 0%- !d0,64 lal&(*j$Ifs$$Ifl40-- y 0,64 lal,8`n$Ifo$$Ifl405-50,4 lal :NPR\^`np$&:<>HJLNPtPRfӵϩӵϝӵϑӵ܎|CJaJ5CJ\aJmHnHuCJj 5CJUj5CJUj5CJUj5CJUmHnHuj5CJU5CJj5CJUCJjCJUmHnHu jCJUj2CJUCJ-$Lgaaaa$If$$Ifl4\5] $-5( 0,4 lalLNPPxPJJJJ$If;$x<$d%d&d'd-DM NOPQ]^a$r$$Ifl405-50,4 lalfhjtvx 468BDFTVjlnxz|ӻ״ڪӑӅj5CJUjR5CJUjCJUmHnHujCJU jCJUjh5CJUj5CJU5CJCJCJj5CJUmHnHuj5CJUj5CJU0FT|$Ifo$$Ifl4204-40,4 lal  2gaaaa$If$$Ifl4$\4"&&-4 0,4 lal   "$.02hj~BDFJLPRVX`b bcdӻ׸ڢڟڛ 5CJ\5\CJCJH*jCJUmHnHu jUCJj*5CJUj5CJU5CJCJCJj5CJUmHnHuj5CJUj>5CJU*24h@BDHJNPTVZ\^$Ifr$$Ifl404-40,4 lal^` 3Mc !-$xa$$a$$ 'a$,&P1h/ =!h"h#$8%@`!Z7+  T0Kxߋ#G~XV=sB58B/֩6poο0BU!t N\sx[Q΃Y/yNL)[oͨ[M@?QշUQ]yJ-;!?׻{O{OV|w}o'?P4{'!,eu!5g}wW%e߽-׿a!}vH돝cg}cn|/?U"m-o2!:~oߤ7B04oHEC%^:% kaէ9-:Vv.TX IaQB5plbYt̆*P=Y໹MC/,fc/)V8A  odÅF6pqlO-U1 a0au XboIC'}yeUx% A厑ʲIp*S ׳,EqM͊5t|0Av u ׇϓk;W\PEĕSpe)J7G ;5nqX\kΘQ@'5ծ1w*p@t3 쮸%"d@Fy[&UH`7zxF5@5 @2|aװ4ߞ}l_6zҘ(~4$AboQA#~kj5sDz XRS óv٫\jFJOƠ3Uf)0TZ*5MβQ Fiw~%sfhG;WF*A۟ C4=kX,h KvCŨ`e#?ssvqtW }2c>ԁhCXs= h; #5 oG6.y{҆cFG5jz3QΛv2g_;vy= ہ8v .4O֏ <@F}r#,Ϝ Ca;+c.-UQ5`;}(YbvR}[NB`)y._.&B mDCl|`[t:x>OAjƔ8]Ztzuxy .&8UX\]ڙ.epF+lUYP Zn_koҸ~uPe` +c،JنQSf%B.d |^.AI FU֝3D\Ħ`k"XT:4dNsadU!PudXVmXduYVQ|ʔ;w0ե"*l712|wva2YUݼ|Z?<\nU}?YHL:[7{G],6HvS_i834۠{kVFdIpf70%;=cO/45Enm6:Dk^Ě:PaMCJ))[ڊJ|Av̯SZgWL_97/Yiy\Sc/=gflyHosoJy X\^o'=m+ŋMk6 Y \.,`M^3d7ј5n`fT.di®%XtK+ezݩӫ; - ]N&bFk6V=a5ljڸ6Gd)=tp_m]^Mhmk;VcѠ^]c\DtWإR`C`r2[(QlDȚMHk cͦ5vA<-rBE=m؁@oj^?]J]8ҹbpoTcaǭh64n>$w8y FyDu2wt%s'n@xm(ЃNC=&)R&Ags,[6E}^z=deC`}W`- 0P`FPaT/Ap͇%{]P6^i m!b@mZ%o3d6 {q,=d{2 d1" _z-[VYgv"@p*t,{+}@Qaɐo58'lB$aϽ G626Kɀ9bHs(0-0XWj{nʍR<^5Sn<ƮT m<~2ڴ|sKhbbG:+ ỉ?Yk_c9,T*10k9Znb¶Xg*%+CpX5۶|S^ ̲ "Su۱+y~V:YCd1RuQ_!O"j Q$gd)2d߱lo1ΫlH8&TZv=y/t'\Quz=ez^ df,L0 x01KV$)زf6!%8Aw֨ `;8I 9`0 !_,K p sЂzya7_Qa)*6:@"` Z:az1`Vav1tlY];`9I_fd~ٙ'?H΃9Y 9y45ى@G|TX\ "rtr  xysllHydWiӼ 3a15}\ ^tdQsٹ\[g*M졵Gx >Q0Q-0ٸU]GQx"R@5(Oy2xMwجcáN#vluβXov5j(!pD-Ьk`Y k =!eO(/S 3ǸA.CCϮN$b}3m°Xʀ/5:DJo1C\U* 'ГNtea0tn~&,ҽ{bHT{ ;'z3 ":)V}1CbDlYHH,;6KRUWcQ a99*ul W@@i4bnhvRqʸ CnX(RC<◶T9jdrgug[dy}ww?X@U^,I.7vq?bc';٨.}d2[KY+ ްkk^t?WWF1 %4E󕇒dFRXamsz)/DPVjv|  $06=IOcou(.7CIP\bv(4:O[au4@F F'FFFFTFTFTFTFTFTFTFTFTFTFTFTFTFTFTFTFTFTFTFTFTFTFTFTFTFTFTFTFTFTFTFTFTFTFTFTFTFTFTFTFT  89/Xb$')c3ķƉޟ,)\2$Z.N@ 8*(  \B  S D1"?bB ) c $D"?\B 5 S D1"? \B 7 S D1"?\B 8 S D1"?B S  ?(  V  C A"?yz01 )-t)4)t8l"-"t5$ I4It7lI-ItW,T Text15Text16Text17Text18Text7Text8Text9Text11Text13Text10Text12-Gb  /?Yt    3333TDEC`C:\Documents and Settings\BG34032.BG3419WK63375\Application Data\Microsoft\Templates\CN-1090.dotTDECUC:\Documents and Settings\BG34032.BG3419WK63375\My Documents\Drivel\Forms\CN-1090.dotTDECUC:\Documents and Settings\BG34032.BG3419WK63375\My Documents\Drivel\Forms\CN-1090.dotTDECF:\McDocuments\CN-1090.dot@Zu 1XY~k8QRw0Kde<cdH @ SX\MSSp PPPP P PPPP,@UnknownGz Times New Roman5Symbol3& z Arial3z Times"1h͚곆?)!h0d2QHP+DEPARTMENT OF ENVIRONMENT AND CONSERVATION TDECTDECOh+'0 ,8 T ` l x,DEPARTMENT OF ENVIRONMENT AND CONSERVATION EPATDECTMEDECDEC CN-1090.dotTDEC90.4ECMicrosoft Word 9.0O@Ik@=Hr@‘Ls@~?՜.+,0$ hp  State of Tennessee ,DEPARTMENT OF ENVIRONMENT AND CONSERVATION Title  !"#$%&'()*+,-./023456789:;=>?@ABCDEFGHIJKLNOPQRSTVWXYZ[\_Root Entry F`aData 11Table<!WordDocumentKaSummaryInformation(MDocumentSummaryInformation8UCompObjjObjectPool``  FMicrosoft Word Document MSWordDocWord.Document.89q