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<br />NATIONAL POLLUTANT DISCHARGE EIJMINATION SYSTEM (NPDES) Form Approved.
<br />DISCHARGE MONITORING REPORT (OMRI OMB NO. 2040-0004
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<br />~_ ~ ~ i 71 c q n ~ ~ r (~ •, •, T' ,, ~_, ~ Approval expires 05-31-98
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<br />NAME/TITLE PRINCIPAL EXECUTIVE OFFICER I CERTIFY UNDER PENALTY OF LAW THAT I HAVE PERS
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<br />AND BASED ON MY
<br />EIN TELEPHONE DATE
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<br />' AM FAMILIAR WITH THE INFORM
<br />INQUIRY OF THOSE INDIVIDUAL
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<br />I BELIEV ATION SU
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<br />ACCURATE AND COMPLETE. I AM AWARE THAT TH ERE ARE SIGNIFlCANT
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<br />97O-B7O-2712
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<br />~nvlronment?I F+lanae~e~r PENALTIES FOR SUBMITTIN G FALSE INFORMATION, INCLUDING THE (J
<br /> POSSIBILnY OF FlNE AND IMPR ISONMENT. SEE 19 U.S.C. 41001 AND 33 U.S.C. SIGNATURE OF PRINCIPAL EXECUTIVE
<br />TYPED OR PRINTED mex/mummneWer under tneve san4es may Incluee Mes up m ff0,1N10 end a
<br />pdsunment or beMeen6montM ene5y>tem.1 OFFICER OR AUTHORIZED AGENT
<br />NUMBER
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<br />COMMENTS AND EXPLANATION OF ANY VIOLATIONS (Reference all enacnments Here)
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<br />EPA Form 332p•1 (08-95) Previous editions may not be used. (REPLACES EPA FORM T-40 WHICH MAY NOT BE USED.) ,1„~ t ,t ~ ~ i ~ it ~ ~_) r ~ I, PAGE bF
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