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PERMIT7EE NAME/ADDRESS pkLdrfaLlryNer~luulw /~IIQ a) MATIOMK POLLUTNiT DISCHARGE ELIMINATON BYSfE/A (NPDESJ Form Approved.
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<br />NAME $ENk;CI CJAL C019PA-ii ~ DISCHAR6EMONlTORINGREPORT'(D' f.: ~ACUSE YES TESTIMGD~
<br />Ap ro I e I 5.31-98
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<br />ADDRESS UR1ilER D ~
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<br /> NAME7fITLE PRINCIPAL EXECUTNE OFFICER I CEI1TIFr UNDER PENALTY. OF LAl~W,THAT I HAVE PERSONALLr E%AMINED AND TELEPHONE DATE
<br /> AM FAMILIAR WITH THE INFO
<br />MY INDUIRr OF THOSE IN RMATION SUBMITTED HEREIN; AND BASED ON
<br />DINDUAES IMMEDIATELY RESPONSIBLE FOR
<br /> OBTAINING THE INFORMATION , .I BELIEVE THE SUBMTTTEb INFORMATION IS
<br /> TAUE. ACCUMTE AND COM RETE.. 1~ AM AWARE THAT THEAE ARE ay--.
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<br /> SIGNIFICANT PENALTIES FOq SUBMITTING FALSE INFORMATION; INCLUDING ~ -
<br /> THE POSSIBILITr OF RNE AND I
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<br />COMMENTS AND EXPLANATION OF ANY VIOLATIONS lRelerence sp sffechments here)
<br />SEE PLRT I. A.4 F'OR DETAILS OP TEST PADCLDUR6. HBPORT LOYSST DILUTION (X BPPLDEMT) YNICN I$ LEINAL TO
<br />SOY UP TEST ORGIIMISDS (LCSO~ A/D ATTACH ICUTH TOYICZTr i85:T xERORT PORa TD DllR. COPIl5 OP ALL
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<br />~ ~ '. PAGE OF
<br />A Form 33 O-1 1 5-95 PrevlGUe a /pons may e,ue /REPLACES EPA FORM T~0 WHICH~MAV NOT BE USED.1
<br />,, OODbL~9B0914-042.3. 1
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