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PERMITTEE NAME/ADDRESS pryi,4 F.edry Na./Lxulm (/DIQ rur!
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<br />ADDRESS G R A it E A D
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<br />NATIOXAL POLLUTANT DISCNMGE FLIMINATOM SYSTEM (NPOE$1 Form Approved. - '
<br />DISCHARGE MONITORING REPORT (DMRI ~, I _- C H A F v °_ T'T i R I N(1MR~:,No. 20AG-0404
<br />l1-fel ff7-191 APProvel e><pires.05-31-98
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<br />NAME/TITLE PRINCIPAL EXECUTIVE OFFICER I CERTIFY UNDER PENALTY Of UW THAT I HAVE PERSONALLY EXAMINED AND ~ TELEPHONE
<br />AM FAMILIM WITH THE INFORMATION SUBMITTED NEREIN; AND BASED ON
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<br />r MY INQUIRY OF THOSE INDIVIOUKS IMMEDIATELY RESPONSIBLE FOR '
<br />(UG4 U `5 a~,•o„5 OBTNNING THE INFORMATION, I BELIEVE THE SUBMITTED INFORMATION IB
<br />1 AM AWARE THAT THERE ARE
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<br />SIDMIFCANT PENALTIES FOR SUBMITTING FALSE INFORMATION, INCLUDING
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<br />SEE 1B U.B.C. 1 1001 AND ]3
<br />THE PO]SIBIUTY OF FlNE AND IMPW ]ONMENT
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<br />COMMENTS AND EXPLANATION OF ANY VIOLATIONS IRe/erence s!I sttschmints Asrel J
<br />TSS i, IHUN LIMITS WILL sE YAIYEG AYD S~TTLEn9LE SG LIDS LIP IT PFFL1lC !CH C=1CYF,24Hf1 PAFCIP EYE9T; 'T SS t;
<br />IRJh LIMITS 'aAIYED FUF >10YE1,24Hk PHECIP 3YENT SUBJECT CO P..UFCFN CF FFCGP IN S.A.T. UIL E GREASE-St'.E
<br />EPA Form 3320-1 (08-95) rPrevious redi one mey be used. R T IREPLACE6 EPA FORM T~0 WHICH MAY NOT BE USED.1
<br />OGG69/97]031-1513 PAGE loF
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