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<br />uw uCT~T~ C eOlAiMbA4 CYFMITNC .
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<br />CI[:FY 1 CERTI ..
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<br />FY T1110ERPEMALtt OF L AW THAT a HAVE PEeSO NALIY ExAMI NED MD / ,/ / TELEPHONE ~ ' GATE
<br />~Jj Y} 1 P I ('. ~,~ F /~(1 ixr tnuuun yr Toast ~~ruvKS win. w. ~ i ~-
<br />o9TAININO THE {pFggMATION 1 eEDEVE T1IE SIMMITTED INFOIIMATlDN IS
<br />TRUE, ACCU1uTE MD COMPLETE. 1 AM AWME THAT THERE ME ~ ~'z
<br />it '~~ t } 1 ( SIG IFICANT PERALTIf9 FDII SU9MITTINO f.AL9E INF011MATION, INCLUgNO ,- / ~ ~ /f ~ ~-,
<br />~ ~ ! ~1 A '!( THE P059ieILltt OF NE AND IMPN90NMEAlT. SEE to U.9.C. P 1001 MD JJ {IONATi1NE O~MIINCNAL EXEC'UTNE ~ ~ ~'
<br />U.S.C. E 1JLe. lbtWNS• uNr iMw mwn• nrY hcAW INr• w ro I /0,000 NUMBEIY YEAR MO DAY
<br />' TYPED OR PRINTED •n•s•m•rhn•rr YnA'IA'/MM•r of Mtw••n[manq•rMF/v><l OFFICER OR AUTHORED AOENT CODE
<br />COMMENTS AND EXPLANATION OF ANY VIOLATIONS /Rdlitnc}wll Athchmmts haul
<br />L.IL t GfidA$E BEPORTIYG-SEE 1•B.1+<C~ 30 DAY AYERAGE.IS dlGrfEST riOFiTHLY AYG. UUHIti~ PERIOD HEPCRTED. TLS
<br />~HeLL bE 3AePLED OY A AONTHLY dA5TS UYYIL SLY SAlSPLiS HAYS BEEP AMALY2E0; THEIiEAPTEfl, pUAflTERLY
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<br />EPA Fam 3320.1 IOS•961 Prsvioue editions mey be uoeE. (REPLACES EPA FORM T-40 WHICH MAY NOT 8E USED.) . v u ~ I i. / ~ G i. 2 ~. ~- U 943 PAGE iJF
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