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<br />NATONAL POLLIJTAM DISCHARGE ELIMINATION SYSTEM MPOESJ FOnn AppfOVBd. I
<br />DISCHARGE MONITORING REPORT (DMR~ n OMB No. 2040-0004
<br />^ , ~ n ~ 7 4 1 n ^ ~ ! _ I (, ^ Approval el~ires 0531-88
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<br />PARAMETER (46-53 (501 3B<5) (46-53) (54-81) EX OF TYPE
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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 PERSO
<br />ATION SUBMITTED HERE NALLY EXAMINED AND
<br />IN; AND BASED ON MV TELEPHONE DATE
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<br />lilis INQUIRY OF THOSE INDIVIDUAL
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<br />I BELIEV S IMMEDIATELY RESPONSIBLE FOR OBTNNING
<br />E THE SUBMITTED INFORMATION IS TRUE ~ / ~ )
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<br />I AM AWARE THAT THERE ARE SIGNIFICAM ,~ //~~
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<br />PENALTIES FOR SUBMfITN G FALSE INFORMATION
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<br />2712
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<br /> POSSIBIUTV OF FINE AND IMPR
<br />~ M ISONMENT. SEE 16 U.S.C. 51001 AND 33 U.S.C.
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<br />NUMBER
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<br />COMMENTS AND EXPLANATION OF ANY VIOLATIONS (Re/erence all attachments here)
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<br />EPA Form 3320.1 (OB-95) Previous editions may not be usedA '(REPLACES EPA FORM T30 WHICH MAY NOT BE USED.) n ~ 1 T ~ I ~ ; ~ I; 1 7- T 5 7 rl PAGE I OF
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