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<br />NATIONAL POLLUTANT DISCHARGE ELIMINATION SYSTEM (NPDES)
<br />DISCHARGE MONITORING REPORT (DMR;
<br />Form Approved.
<br />OMB No. 2040-0004
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<br />NAME/TITLE PRINCIPAL EXECUTIVE OFFICER I CERTIFY UNDER PENALTY OF
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<br /> THE INFORMATION, I BELIEVE THE SUBMITTED INFORMATION la TRUE, O
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<br />(~ TI ~ ~ ~ ~ ~ POSSIBILRY OF FINE AND IMPRISONMENT. SEE tB U.S.C. § 1001 AND 33 U.S C SIGNATURE OF PRINCIPAL EXECUTIVE ' ill Y.~9'jLU) L I1 ~ !~
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<br />TYPED OR PRINTED § t319. (Ponettles untlar Ihase srelules may include lines up to Eto,WO entl or
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<br />COAQMENTS AND EXPLANATION OF ANY VIOLATIONS (Reference all attachments here) ~ '~ ~ 'T!~"s
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<br />PA Form 332b1(08-95) .Pfeyious editions may not be used. _ (HEBLACES EPA FORM T-40 WHICH,MAY NOT BE USED) , ~~a ' ~P,AGE OF
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