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PERMfTTEE HAME/ADDREBS (Ae-,6frleryNarLxmrm /D16oaU NATIONAL POLLUTANT DISCHMOE ELIMINATION SYSTEM INPDES)
<br />NAME ,~ ~ - c r ~ n •{ p ^ v cr 'YC- Q, [ krc~ W , DISCNARGE MONITORING REPORT IOMRI
<br />(2-I61 1 J-197
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<br />sL•~ ~'i .x ~') '~) ~ 1 kc 237
<br />FACILITr ~'~~e / 1 ~~' MONITORING PERIOD
<br />~^°' YEAR MO DAY YEAR MO DAY
<br />LOCATIONy ~_ -,. ; q ^ p -I ] 7 9 7. FROM '1' :, n I, TO 1 ~l :; u
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<br />Form Approved.
<br />~'^'I (IF F' Pr"3~ 7/~°1-`OMB~No~2040-0004c-;,
<br />(; rl 1, f+ .. ;,1 Approval sxpirea 06-'31-98
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<br />131371 EX ANALrsIS TYPE
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<br />NAMERITLE PRINCIPAL EXECUTIVE OFFICER I CERT
<br />AM FA FY UNDER PENALTY OF
<br />MILIAR WITH THE INFO lAW THAT I HAVE PERSONALLY El(AMINEp AND
<br />RMATION SUBMITTED HEREIN; AND BASED ON TELEPHONE DATE
<br /> MY INQUIRY OF THOSE INDIWDUAL9 IMMEDIATELY RESPONSIBLE FOR '
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<br />+r- OBTAINING THE INFORMATION, I BELIEVE THE SUBMITTED INFORMATION IS
<br />TRUE
<br />ACCUMTE AND COMRETE
<br />I AM AWARE THAT THERE ME _ ~:\~ ~
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<br />SIGNIFICANT PFNAlTlE9 FOR SUBMITTING FALSE INFORMATION
<br />INCLUDING ~
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<br />6 @. .. t J G I M A E1 w ~ e / ,
<br />THE POSSIBILITY OF RNE ANO IMPRISONMENT. SEE 18 U.S.C. E 1001 MID ]]
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<br />SIONATURE OF PRINCIPAL EXECUJNE
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<br />COMMENTS AND EXPLANATION OP ANY VIOLAI IONS (Rl/erenca s// etteMmenls /late/
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