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<br />~ tL1MElTRLE PRINCIPAL EXECUTIVE OFFICER I cERnFr uND01 PENUtr of Lww THAT I NAVE PmsoNAUr ExAMINFD AND ~ TELEPHONE DATE
<br />- AM FAMIIAR WITH THE INFORMATION SUBMITTED HEREIN; AND BASED ON _
<br />MY .INQUIRY OF THOSE 'INDINDUAL9 IMMEDIATELY RESPONSIBLE FOR
<br />l Q ., f~ 1 L'~"E I~ OBTAINING THE IMFORMA710N, I BELIEVE THE SUBMITTED INFORMATION 19, I ~ - ., ` ~'." "t•~ 5 >~ '
<br />+ ~- ~ TRUE, ACCUMTE MID COMPLETE. I AM AWME THAT THERE APE. I ~. = '~ ~ ,i
<br />_ ~ ' SIGNIRCANT PENALTIES f011 SUBMITTING FALSE INFORMATION, INCLUDING
<br />' I AJPTI `' ~/1 ~ ~ ~?Cl ~~` E' ~ THE PoSSIBIIITY OF flNE AND IMPPoSONMENT. SEE 14 U.S.C. 1 7001 AND 9] BN7NATUEIE OF PRINCIPAL EXECUTIVE ~ ~ ~r
<br />[~~ U.S.C. / 1]14. OLrklu uIM OI.r mtuna SMY iKA/!I Av Ip m F/0,000 R A
<br />TYPED OR.PRINTED ens er mnln..n MIMAa.rwnrWbnrw.tmonlM rtleYroAl OFFlCER OR AUTHORIZED AGENT OE NUMBER YEAR 'MO DAY
<br />COMMENTS AND EXPLANATION OF ANY VIOLATIONS /Refsrmce e!! etteehmenb heel ~ ~ ~ ~ ,
<br />~SS~E'TUTAL`-I'FZOiI LI?11T5 uILL 8E .I AIVEDF 6 SF.TTLEA?iLt SuL1U5 LIH[TS APnLIED, FUk IUYkP24Hii kEtIP EVENT )
<br />~"Ii<SSr .IkUN G 5CTiLEAt)Lf SULIUS LIM[TS NAIVEO F(!K IOYP.F24HR PR£C1P tVF'N7-AiTdCH pOCU?1ENTAT[UN-SSE I.A.3.
<br />am 20.1 (08.96) Previous editlons mey be used. (REPLACES EPA F R T4 HICH MA • NOT BE USED. AGE
<br />~f,}~ - - UUU3b/967424-0931 - ~-- ..
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