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PERMITTEE NAME/ADDRE56p~birWryNaa/for., non l/Dlpnnp NATIONAL POLLUTANT DISCHMOE EUMINATON BfBfEM //NPDES/
<br />DISCHARGE MONITORING REPORT lOMR1 Form Approved. _ 7
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<br />NAMERITLE PRINCIPAL EXECUTNE OFFICER I CERTI
<br />AM FA FY UNDER PENN.TY OF
<br />MILIM WITN THE INFO LAW THAT I HAVE PERSONALLY EXAMINED AND
<br />RMATION BUBMITTED NEREIN; AND BASED ON TELEPHONE DATE
<br /> MY INQUIRY OF THOSE INDINDUN.S IMMEDIATELY RESPONSIBLE FOR
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<br />ti ~/,1 " -f~ OBTNNINO THE INFORMATION, I BFLIEVE THE SUBMITTED INFORMATION IS
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<br />I TRUE, ACCURATE AND COMRETE. 1 AM AWARE THAT THERE AIIE
<br />- SIGNIHCANT PENALTIES FOR SUBMITTING FALSE INFORMATION
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<br />/r ~, _ THE POSSIBILITY OF RNE AND IMPNSONMEMT. SEE 1B U.S.C. 1 1001 AND 37
<br />BIONATURE OF PRINCIPAL EXECUTNE . - • / , r °' -
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<br />RINTED Ans ar.nni„unb,Arl.E+yrr+r Ey an..a,an,N,m..lesy.rral OFFICER OR AUTHORO:ED AGENT- CODE NUMBER YEAR MO DAY
<br />COMMENTS AND EXPLANATION OF ANV VIOLATIONS /Rv/Trance al/ srraehmants hare!
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