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<br />DISCHARGE MONITORING REPORT (DMR1 OMB No. 2040-0004
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<br />NAME/TITLE PRINCIPAL EXECUTIVE OFFICER I CERTIFY UNDER PENALTY OF LAW THAT 1 HAVE PERSONALLY E](AMINED AND
<br />AM FAMILIAR WITH THE INFORMATION SUBMITTED HEREIN: AND BASED ON MV TELEPHONE DATE
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<br />l INQUIRY OF THOSE INDIVIDUALS IMMEDIATELY RESPONSIBLE FOR OBTAINING
<br />THE INFORMATION. I eELIEVE THE SUBMITTED INFORMATION IS TRUE. '
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<br />Richard Mil ACCURATE AND COMPLETE I AM AWARE THAT THERE ARE SIGNIFICANT
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<br />PENALTIES FOR SUBMITTING FALSE INFORMATION
<br />INCLUDING THE ~ ~
<br />Environmental Manager ,
<br />pGSSIBILITY OF FINE AND IMPRISONMENT. SEE I6 U.S.C.41001 AND BJUS.D.
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<br />SIGNATURE OF PRINCIPAL EXECUTIVE 97 -87D-2712
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<br />TYPED OR PRINTED 31 e. (
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<br />enalties untler these statutes may Include lines up ro EI6,000 entl ar
<br />rnexrmum imprisonment of beAVeen6montns end5yeers.) OFFICER OR AUTHORIZED AGENT Q NUMBER YEAR MO DAY
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<br />EPA Form 3320.1 (08.95) Previous editions may not be used. ^ ~ (REPLACES EPA FORM T-40 WHICH MAY NOT BE USED.) PAGE OF
<br />00103/000405-1501 1
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