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<br />NATIONAL POLLIfTANT DISCHARGE ELIMINATION SYSTEM (NPDES) Form Approved.
<br />DISCHARGE MONITORING REPORT (DMR~ OMB No. 2040-0004
<br />tz-ts~ 07- P) ' t T ~ " Approval expires 05-31-98
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<br />(3z37) AVERAGE MAXIMUM UNITS MINIMUM AVERAGE MAXIMUM UNITS (~sJl (~LSB15 69-70
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<br />NAME/TITLE PRINCIPAL E%ECUTNE OFFICER I CERTIFY UNDER PENALTY OF LAW THAT I HAVE PERSO
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<br />INQUIRY OF THOSE INDNIDUALS IMMEDIATELY RESPON
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<br /> POSSIBILITY OF FINE AND IMPRISONMEM. SEE 1B U.S.C. 4 1001 AND 33 U S.C. SIGNATURE OF PRINCIp AL'E7~CUTIVE
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<br />COMMENTS AND EXPLANATION OF ANY VIOLATIONS (Relerence ell attachments here)
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<br />Epp Form 3320.1 (0&95) Previous editions may not be used. (REPLACES EPA FORM T~0 WHICH MAY NO7 BE USED.) ,t ,T T T ,1 / ~ a ~ U) ~- ! S 7' PAGE r OF
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