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<br />NATIONAL POLLUTANT DISCHARGE ELIMINATION SYSTEM (NPDES) Form Approved.
<br />DISCHARGE MONITORING REPORT (DMR; OMB No. 2lY1o-0004
<br />1z-+sl (+~- 91 ~ ^ T ~ " Approval expires 05.31-98
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<br />NAME/TITLE PRINCIPAL E](ECUTNE 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 MY TELEPHONE DATE
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<br />RICFIaI'd x.1111$ INQUIRY OF THOSE INDIVIDUAL
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<br /> POSSIBILITY OF FlNE AND IMPR ISONMENT. SEE 18 U.S.C. 51001 AND 33 U.S.C. SIGNATURE OF PRINCIPAL El(ECUTIVE
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<br />COMMENTS AND EXPLANATION OF ANY VIOLATIONS (Reference ell attachments here)
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<br />ERA Form 332o-1 (OB-95) Previous editions may not be used. ~ (REPLACES EPA FORM T-90 WHICH MAY NOT BE USED.) r „ ~ ~ ., F ~ ~ „ U 1 ~- ~ _ ~ „ PAGE ~ OF
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