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<br />ITANT DISCHARGE ELIMINATION SYSTEM (NPDES) Form Approved.
<br />As GE MONITORING REPORT (OMR;9I r I `~ C f OMB No. 204D-0004
<br />Approval expires 0537-98
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<br />NAME/TITLE PRINCIPAL EXECUTIVE OFFICER I CERTIFY UNDER PENALTY OF
<br />AM FAMILIAR WITH THE INFORM LAW THAT I HAVE PERS
<br />ATION SUBMITTED HER ONALLY EXAMINED AND TELEPHONE
<br />EIN: AND BASED ON MV DATE
<br />1 INQUIRY OF THOSE INDIVIDUAL
<br />I BELIEV
<br />THE INFORMATION
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<br />A S IMMEDIATELY RESPON
<br />E THE SUBMITTED IN SIBLE FOR OBTAINING ~
<br />FORMATION IS TRUE
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<br />ACCURATE AND COMPLETE.
<br />I AM AWARE THAT TH .
<br />ERE ARE SIGNIFICANT ~.I
<br />M K:Y (ti PENALTIES FOR SUBMITTIN
<br />POSSIBILITY OF FINE AND IMPR G FALSE INFORMATI
<br />ISONMEM. SEE 1b U.S. ON. INCLUDING THE ~ I ~-~~~.~
<br />C. 4 1pD1 AND 33 U.S C. `SIGNATURE OF PRINCIPAL E ECUTIVE ~I /.O ~") {,
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<br />§ 1319. (Penalties untler these statutes may inclutle lures up to Etfl,n00 end ar OFFICER OR AUTHORIZED AGENT NUMBER YEAR MO DAY
<br />TYPED OR PRINTED maximum imprisonment of beMree nbmrnths entl5yeers.) CO
<br />COMMENTS AND EXPLANATION OF ANY VIOLATIONS (rrererence err arrecnmenrs nere)
<br />iC DAY AYEI3AGF 25 F.ICtE`T t'GAThLY nVG. CIiFIAG r'EFICC fik.FCFTEL• GIL L'~GFE'ASF. - SEF I.h.l.L. F. 5.
<br />(08.95) ~ Previous editions may not ba.;tised, (REPLACES EPA•FORM T-40 WHICH MAY NOI
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