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<br />' dAiD£It CO 81639
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<br />LocATlo"ti ACUfiM CO 91630
<br />ATTi: G. 80D BRUHM. GEeiEtiAL PlAYAGEr
<br />NATIONAL POLLUTANT DISCNMDE ELMINATION 91'STEM (NPDESI
<br />DISCHARGE MONRORING REPORT lOMRI
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<br />Form Approved.
<br />OMB No. 20 -004
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<br />NAME7TITLE PRINCIPAL EXECUTNE OFFICER I cERnFr UNDER PENUrr of
<br />AM FAMILIAP WITH THE INFO uW THAT I HAVE PEASONNLy ExAMI
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<br />MV INOUIRV OF THOSE INDINDUK9 IMMEDIATELY RESPONgB LE FOR
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<br />~M ~' f-+ OBTNNINO THE INFORMATION, 1 BELIEVE THE SUBMITTED INFORM ATION 19 / I
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<br />TRUE. ACCURATE AND COMPLETE. I AM AWARE THAT THE
<br />gGNIFICANT PENALTIES FOR SUBMITTING FALSE INFORMATION
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<br />THE POSgBILITY OF HNE AND IMPRISONMENT. SEE 1B U.S.L. 1 1001 AND 37 v gIONATURE
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