WPC  3Vz/Q<H{/9~.\r1uP~Uo_bMǣ~"\rp+Q. }3&p;kz~BR3LCYħ+9.9+Tϣ/$l})yv:es_Y\#QZyGƝjZ/'pͩM)Zԃ0h߫^W bK.)40 =zEz&[㚈PWnGGi|f.$wC e)\4ݪBCvR qWGR˿ʑưJ$S{>χ)*Pi YbV82+27u`"Xwx4\J-3uh`j o;K6凥mWl) +S'۲dЮۈZ-=_{==#B3E#p Exn`}MMMw#K LFyK#_eU>B 0" 0` 0>fZa\ B p D+ 0#bUN+ %y M ( N ^ w 4  m \  `&Times New Roman' Rebecca L (Government User0Steve Roy .   h:Default ParaDefault Paragraph FontXXX`:Footnote RefFootnote Reference($  0  Table_A  d'dxd#|x(r$..       XtXX XXtXX Xt\\US_EPA\R5WATER_16-21_9000.WATER.JACKSON.R5.CENT.EPAdddddddd0(9 Z6Times New Roman Regular X n8Z rZp7:i+00U  !..       XtXX XXtXX Xt  _       iUX4` <hDp Lx (#XiRebeccaL.Harvey,Chief  UndergroundInjectionControlBranch  U.S.EnvironmentalProtectionAgency | 77WestJacksonBoulevard,WU-16J b Chicago,Illinois60604-3590 H DearMs.Harvey:  d 33ThisletterrequeststhattheattachedStateBond#__________________intheamountof  0 $__________________beconsideredanacceptablemechanismformeetingtheFederal  C  UndergroundInjectionControlprogramfinancialresponsibilityrequirementforthefollowing V  well: i  1.WellName__________________________________________________ ?    <uUX4` <hDp Lx (#X, (#u2.WellLocation: Township______________  Range_________________ R   Section________________  1/4Section_____________ e   <uUX4` <hDp Lx (#X, (#uCounty________________________________________ x  3._UIC_ԀApplication#_____________________________________________  4.Owner/OperatorName_________________________________________  5.Address_____________________________________________________  ______________________________________________________________  ______________________________________________________________ ' 6.Phone(_____)________________________________________________ : IcertifyunderthepenaltyoflawthatIhavepersonallyexaminedandamfamiliarwiththe ` informationsubmittedinthisdocumentandthat,basedonmyinquiryofthoseindividuals #s immediatelyresponsibleforobtainingtheinformation,Ibelievethattheinformationistrue, 6 accurateandcomplete.Iamawarethattherearesignificantpenaltiesforsubmittingfalse I  information,includingthepossibilityoffineandimprisonment.(Ref.40_CFR_Ԁ144.32) \! _________________________________________________________________ o" * ddd Xdd Xdd X(#(#,N %%,O %%,O %%+  @-## d@N.` hp x (#X, (#Nd 0lUX4` <hDp Lx (#X(#ldNameandOfficialTitle K8'#I d dK 0N.` hp x (#X, (#Nd 0lUX4` <hDp Lx (#X(#ldSignature K8'#I"d dK 0N.` hp x (#X, (#Nd 0lUX4` <hDp Lx (#X(#ldDateSignedB86#I$  d B 0K (X<% KuUX4` <hDp Lx (#X, (#ucc:DaveDavis,MichiganDepartmentofEnvironmentalQuality O&!% N.` hp x (#X, (#N