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PERMRTEE NAME/ADDRESS (AdiL F.eWyNr'L«eNU t/DMw.wrJ NATIONK POLLUTMT DISCNMOE FIIMINATON BYSEEM rrNPDESI Form Approved.
<br />NAME T :•+ 4 P ' F R '" • A I V G e I9 C. DISCHARGE MONITORING REPORT 10AIR1 + T ~{!1 R OMB No. 2040-0004
<br />2-le) 17-I91
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<br />NAME/TRLE PRINCIPAL EXECUTNE OFFICER I CERTIFY UNDER PENKTY OF UW TRAT I HAVE PERSONKLY EXAMI
<br />AM FAMIUM WITH THE INFORMATON SUBMITTED HERDN; MD e7 NED AND
<br />1SED OM TELEPHONE DATE
<br />
<br />W. GOrdOD Peters MY INQUIRY OF THOSE INOINDUKS IMMEDIATELY RESPONSIBLE FOR
<br />OATNNING THE INFORMATION, I BELIEVE THE SUBMITTED INFORMATON IS s/p `/
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<br />70-A24-44U 1
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<br />Pt231dent General Manager TRUE, ACCVRATE MD COMPLETF. 1 AM AWME THAT THERE ME
<br />51GNIHCMT PENKTIES FOR SUSMITTINO FKSE INFORMATION
<br />INCLUDING 7
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<br />THE POSSIBILITY OF RNE MD IMPRISONMENT. SEE to U.S.C. E 1001 MD 33
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<br />TYPED O .ntlwmuNx.n hWrisml.Tr alblwNn enlmNl.rM 6~yMa1 OFFICER OR AUTHORIZED AOENi CODE NUMBER YEAR MO DAY
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<br />I.:..1.D, A.FD 11691 BUHDER OF PRDOP R°QU[RENP.BTS UBDEp T.A.3. OLL ? GREASE - `'EE I. P. t.(e), mD5
<br />RnNI1'ORi~9G - I.9.3. 3D DAT AfERAG£ IS R2GRE5} M00TNCf AfPRtGP DTIaTNG ovar~e wPOnuTwn_
<br />meY bs uted. IREPLACEB EPA. FORM T:4.0 WHICH MAY NOT eE V6ED.1 OOD 2 A / 9 4 0 4 21- I O 3 8 PAGE ~ OF
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