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<br />116-53
<br />' 197-371
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<br />NATIONAL POLLUTMT DISCHMOE ELMINATON eYSFEM /NPDESI ~ FOEm ApprOVed.
<br />DISCHARGE MONITORING REPORT (OMRI N T y 1? OMB No. 2040-0004
<br />!3 161 17 191 Approval expires OS-34-9B
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<br />NAMEITITLE PRINCIPAL EXECUTIVE OFFICER I CERTIFY UNDER PENALTY OF UW TNAT t HAVE PERSONALLY E%AMINED MD TELEPHONE ~ DATE
<br />AM FAMILIM VATH THE INFORMATION SIIeMITTEO HEREIN; MD EASED ON ~~ // / _ • _
<br />MV INQUIRY OF THOSE INOINDUALS IMMEDIATFIY RESPONEIELE FOR L /_`~JL"~"~-
<br />W. Gordon Peters OBTNNING THE INFORMATION, 1 BELIEVE THE SUBMITTED INFORMATION IS 970-924-44U l 44 1 27
<br />TRUE. ACCUMTE MD COMRETE. I AM AWME THAT THERE ME
<br />Pre9ldecLt /General Manager AGNIHCMT PENALTIES FOR EUEMITTINO FALSE INFORMATION, INCLUDING
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<br />PA farm 3320.1 (08.96) Previous editions may bs used. (REPLACES A F RM +qQ 1110 _ MAY NOT BE USED.1 (1 Q 1~. 1 / 9'1 t` I'~. 7 ? - 7 n ~ ~ PAGE T OF /
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