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<br />NATIONAL POLLUTANT DISCHMOE ELIMINATION SYSTEM /NPDESI Form Approved.
<br />D16CHARGE MONITORING REPORT IDMRI
<br />I7-lel 117-191 '• ` ~ ~ OMB No. 2040-0004 y
<br />1 - _ - Approvellexpiree 05-31-98
<br />PERMIT NUMBER DISCHMGE NUMBER ~ _ _ _ _
<br />' MONITORING PERIOD ~ ~ ,
<br />YEAR MO DAY YEAR MO DAY
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<br />' !16711 111-731 174751 l7G771 118-191 136371 NOTE: Read Instrualau befoie completlny this form.
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<br /> AVERAGE MAXIMUM UNITS MINIMUM AVERAGE MAXIMUM UNITS (s7.e31 /64681 (69-)Ol
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<br />NAME/TITLE PRINCIPAL EXECUTNE OFFICER I cERn
<br />AM FA Fr UNDER PENMTr OF uw THAT I NAVE PERSONMLr ExAMINED AND
<br />MILIAR WITH THE INFORMATION SUBMITTED HEREIN; AND BASED ON TELEPHONE DATE
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<br />~ Mr INQUIRY OF THOSE INDIVIDUMS IMMEDIATELY RESPONSIBLE FOR
<br />OBTNNING THE INF011MATION
<br />I BELIEVE THE SUBMITTED INFORMATION IS `/
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<br />TRUE. ACCURATE AMD COMPLETE. I AM AWARE THAT THERE ARE
<br />SIGNIFICANT PENALTIES fOR SUBMITTING FALSE INFORMATION
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<br />EPA Form 3320-1 108-95) Previous editions mey ba used. /REPLACES EPA FORM T40 WNICN MAY NOT BE USED.1 PAGE OF
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