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<br />MONITORING PERIOD
<br />YEAR MO DAV YEAR MO DAY
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<br />nA1mE/TITLE PRINCIPAL E%ECUTNE OFFICER 1 CERTI
<br />AM FA FY UNDER PENALTY OF
<br />MILIAR WITN THE INFO UW TMAT I HAVE PERSONALLY E%AMI
<br />RMATION SVBMITTED HEAEIN; AND B NED AND
<br />ASED ON TELEPHONE DATE
<br /> MY INQUIRY OF TNOSE INDIVIDVALS IMMEDIATELY RESPON8IB LE FOR
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<br />? 1 OBTNNING THE INFORMATION, I BELIEVE THE SUBMITTED INFORM ATON 18
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<br />, TRUE, ACCUMTE AND COMPLETE. I AM AWARE THAT THE
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<br />THE POSSIBILITY OF RNE AND IMPRISONMENT. SEE 1B U.S.C. E 1001 ANO 9] 610NATUftE OF PRINCWAL EXECUTNE
<br /> U.S.C. f 1318. IPr+erW. uM~r tlus WNroe mry irArM /8wa W ro i J0,000
<br />TYPED OR PRINTED 'evdrnMx6rn.n inptomwN e/bbrwr6monMa rW6Fwa.l OFFICER OR AUTHORIZED AGENT CODE NUMBER YEAR MO DAY
<br />COMMENTS AND EXPLANATION OF ANY VIOLATIONS IRetarence a6 ettacnments here!
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<br />mey be u9e0.
<br />EPA FORM
<br />Form Approved.
<br />OMf~, No.; 2040-X00,4•r
<br />i - s 05=31-98
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