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<br />NATIONAL POLLUTANT DISCHARGE ELIMINATION SYSTEM (NPDES)
<br />DISCHARGE MONITORING REPORT (DMA;
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<br />Approval expires O~y3~,9Rj,
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<br />PARAMETER (46-53) (54-61) (36-45) (96-53) (54-61) EX OF TYPE
<br />(32-37J AVERAGE MAXIMUM UNITS MINIMUM AVERAGE MAXIMUM UNITS
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<br />NAME(TITLE PRINCIPAL EXECUTIVE OFFICER I CERPFY UNDERPENALTY OF
<br />AM FAMILIAR WITH THE INFORM LAW THAT I HAVE PERSONALLY E%AMINED AND
<br />AND BASED ON MY
<br />ATION SURMITTED HEREIN TELEPHONE DATE
<br />I'. c a r M S INQUIRY OF THOSE INDIVIDUAL ;
<br />S IMMEDIATELY gESPONSIBLE FOR OBTAINING
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<br />Environmental rrlanager THE INFORMATION, I BELIEV
<br />ACCUMTE ANO COMPLETE. E THE SUBMITTED INFORMATION IS TRUE,
<br />I AM AWARE THAT THERE ARE SIGNIFICANT .(^//~ g]O-8]O-2]IZ
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<br /> PENALTIES FOR SUBMITTING FALSE INFORMATION, INCLUDING THE /
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<br /> POSSIBIIfTV OF FINE AND IMPRISONMENT. SEE to U.S.C. § 1001 ANb 33 U S.C. SIGNATURE OF PRINCIPAL EXECUTVE / .J
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<br />TYPED OR PRINTED 4 1319. (Penetties untler Hrese statutes may inclutle lines up ro 5/0,000 eritl w
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<br />Epp Form 332o-1 (OB-95) Previous editions may not be used. (REPLACES EPA FORM T-40 WHICH MAY NOT BE USED.) 0 G I) 0 2 / 00 U 4 G 5-1501
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