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PERMITTEE NAME/ADDRESS Reew.F+eWryesr/(,auran UDrp nq
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<br />NATIONAL POLLUTMT DISCNMGE ELIMINATION SYSTEM (NPDESI FOFm ApprOVed.
<br />DISCNARGE MONITORING REPORT IDMRI ,,. „,. t ., ~ „ . , L, O 8. o. 2040-0004 -.
<br />I1-161 f7-I91 • T,Approvellexpiree OS-31-98
<br />C.707271i4 ~f!c n (^:tn- .1 :? _
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<br />l10-111 l11-131 114151 /76771 l15-191 130.37) -NOTE: Reed inetructione before eomplatin0 this form.
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<br /> !46531 150-611 /3S-I5 /46531 1546/1 EX OF T
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<br /> AVERAGE MAXIMUM UNITS MINIMUM AVERAGE MAXIMUM UNITS IF=
<br />-eJ/ (6465) 16'9-701
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<br />NAME/TITLE PRINCIPAL EXECUTNE OFFICER I CERTI
<br />AM FA FY UNDER PENALTY OF lAW THAT I HAVE PERGONALLV E%AMINED MD
<br />MILIM WITN THE INFORMATION SUBMITTED HEREIN; MD BAGEO ON ~ - ~ TELEPHONE DATE
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<br />I I I;~ MY INQUIRY OF TNOGE INDIVIDUALS IMMEDIATELY RESPONSIBLE FOR
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<br />SIGNIFICANT PENALTIES FOR SUBMITTING FALSE INFORMATION
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<br />THE POSSIBILITY OF FNE MD IMPNSONMENT. GEE 1B U.S.C. E 1001 MD ]]
<br />SIONA7URE OF PRINCIPAL EXECIRNE .
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<br />COMMENTS AND EXPLANATION OF ANY VIOLA71oN5 I1Teference e5 ettecnmsnts nerel _
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<br />EPA Form 3320.1 106-851 Prevloue edlDOne may be used. (REPLACES EPA FORM T40 WNICN MAY NOT BE USED.1 n ~ ~ •I r r ? ., ^ : ~., n t , ; PAGE , OF
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