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<br />NAME ~ ~ ~ ~ ~OISCHARGE MONITORING REPORT (DM +
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<br /> (3 Cartl Onry) QUANTITY OR LOADING (4 Card Onty) ~ QUANTITY OR CONCENTRATION NO: F9EpuENCV SAMPLE
<br /> PARAMETER (46-53) (54.67) ~ ~(3B-45J (46-53) (54-B7J EX 'OF, ~ TYPE
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<br /> NAMElTITLE PRINCIPAL EXECUTIVE OFFICER I CERTI
<br />AM FA FY UNDER PENALTY OF LAW THAT.1 HAVE PERSONALLY E%AMINED.AND
<br />MILIAR WITH THE INFORMATION SUBMITTED HEREIN; AND BASED ON MV TELEPHONE DATE
<br /> - INQUIRY OF THOSE INDIVIDUALS IMMEDIATELY RESPONSIBLE FOR OBTAINING
<br />~R UW~ • VvnTrlZEx THE INFORMATION, I BELIEVE THE SUBMITTED INFORMATION IS TRUE, -
<br /> ACCURATE AND COMPLETE I AM AWARE THAT THERE APE SIGNIFICANT
<br />CLUDING THE
<br /> PENALTIES FOR SUBMITTING FALSE INFORMATION, IN
<br />- POSSIBILITY OF FINE AND IMPRISONMENT. SEE 1B U.S.C. § 1 Wt AND J3 U.S.C.
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<br />~, COMMENT : ' ~ :p EXPLANATION OF ANY VIOLATIONS (Reference all attachments here)
<br />TSS E AL IAOY LII'.I7S MILL BE iIAIYED, AND SETTLEABLE SCCICS LIpIT IFPLIED FCA <=1CYE,i4rE EEECIF HYENT-
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<br />,,Q ~ USED.) 0 0 19 9 / C O C 1 1 7 - 1 6 i i PAGE I OF
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