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<br />NAME/TITLE PRINCIPAL EXECUTIVE.OFFICER I CERTIFY UNDER PENALTY Of LAW THAT:I HAVE PERSONALLY EXAMINED MD TELEPHONE DATE
<br />AM FAMILIM WITH ME INFORMIl{{TIDN ~UeMITTEO HEREIN; MD BASED ON ~ ~
<br />MY INQUIRY OF THOSE 'IXDIVIDDALS IMMEDIATELY RESPONSIBLE FOR "
<br />OBTNNING THE INFORMATION, I BELIEVE THE SUBMITTED INFORMATION IS
<br />RlCIIaYCI MIIIS TRUE. ALCUMTE AµND CGMPLETE. T AM AWAgE THAT THERE ME ~
<br />SIGNIFICMT PENKTIES FOR SUBMITTING FALSE INFORMATION, INCLUDING
<br />Environmental 141ana er THEPOSSIBIUTYOFGINEMDIMPW90NMIXT.SEEIBU.S.C.f1001MD77 ] - ~ 28 99
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<br />TYPED OR PRINTED .narmu:m.n Nwlro++irrewan.wn emminaW6rrral OFFICER OR AUTHORIZED AGENT CODE NUMBER YEAR MO DAY
<br />COMMENTS AND EXPLANATION OF ANY VIOLATIONS /Relrrsncd~6//sttschments here)
<br />~cTJLtAiiLt SULIJS LIMIT ivAIYEO FOR lOYRrl~HK PKtGIN EVrrNT-Stt I.A.3. PG [V, FUR LtEaU1REMENi4. LIL
<br />ukEAit GKAd SAMPLt ANALYSIS kEQUIRED.IF V15IdLL SMcEN IS GBStRVEU. URT12LY SAMPLING INSTRUGilONS-I.(,.d,
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<br />EPA Form 3320-7 108-961 Previous editions mey be used. (REPLACES EPA FORM T~10 WHICH MAY NOT BE USED.) ~ U02O$ /961 OO 1- 13.11. PAGE ~ lOF
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