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<br />NATIONALPd1UTANTbISCHARGE ELMINATION SYSTEM MPDES) Form Approved.
<br />DISCHARGE MONITORING REPORT IDMgI OMB NO. 2040-0004
<br />,I u l 7 ,) u A Approval expires Ob31-88
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<br />PERMIT NUMBER DISCHARGE NUMBER I -` 1 b F 1 L k L t d
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<br />PARAMETER (48-53 (54-61) 38-45 48-53 5457 EX OF TYPE
<br />(32,37) AVERAGE MAXIMUM UNITS MINIMUM AVERAGE MAXIMUM UNffS auLYSls
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<br />NAME/TRLE PRINCIPAL EXECUTVE OFFICER I CERTI FY UNDER PENALTY OF l AW THAT I HAVE PERSO NALLY EXAMINED AND TELEPHONE DATE
<br /> AM FAM ILIAR WITH THE INFORM ATION SUBMffTED HERE IN; AND BASED ON MY
<br />.. ~ INQUIRY OF THOSE INDNIDUAL S IMMEDIATELY RESPONSIBLE FOR OBTAINING
<br />- ~ ~ ~ THE INFORMATION, I BELIEV E THE SUBMITTED INFORMATION IS TRUE, J
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<br />ACCURATE AND COMPLETE.
<br />1 AM AWME THAT THERE ARE SIGNIFICANT ~
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<br /> PENALTIES FOR SUBMITTING FALSE INFORMATION, INCLUDING THE
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<br />PoneN'as untlw Brew s SONMENT. SEE 1B U.S.C. § 1001 AND 33 U.S.G
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<br />EPq Form 3320.1 (08.95) Previous editions may not be used. (REPLACES EPA FORM T-40 WHICH MAY NOT BE USED) C P 1. ~ !) ~ .y ~ ~ ~ 1 E - 7 c_ i t PAGE L OF
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