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<br />DISCHARGE MONITORING REPORT IDMRI - ,OMB No 2040-0OQ4.,
<br />1Z-161 17-191 1 .. ~ /' 1 '
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<br />NAME(TITLE PRINCIPAL EXECUTNE OFFICER I CERTIFY UNDER PENALTY OF
<br />AM fANOLIM WITH THE INFO lAW TNAT I HAVE PERBONAILY EXAMINED MD
<br />RMATION SUBMITTED HEREIN; MD BARED ON ~
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<br />! TELEPHONE DATE
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<br />ISC}1'1Tfj JL. j~ MY INQUIRY OF THOSE INDINDUALB IMMEDIAT0.Y RESPONABLE FOP r
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<br />i OBTNNING THE INFORMATION, I BELIEVE THE SUBMITTED INFORMATION IB . ~ _. _
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<br /> THE POSSIBILITY OF FINE AND IMPRISONMENT. SEE 1B U.S.G. E 1001 Mp 7] SIGNATURE OF PRINCIPAL EIEECUTNE ,
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<br />TYPED OR PRINTED rM rmuinun MFrlwmrwrer Mrwwn smurAr rwslr.l OFFICER OR AUTHORIZED AGENT CODE NUMBER YEAR MO DAV
<br />COMMENTS AND E%PLANATION OF ANY VIOLATIONS lReTerene6 sn sttscnments nerel
<br />EPA Form 3320-1 100.961 Previous editions mey be used. (REPLACES EPA FORM T~0 WHICH MAY NOT BE USED.1 PgGE OF
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