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<br /> NATIONAL POLLUTMT DISONMOE ELIMINATION BYSTEM /IIY~E$1
<br />DISCHARGE MONITORING REPORT lDA1R1
<br />_ 12-15! 17-I91
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<br /> PERMIT NUMBER DISCHMOE NUMBER
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<br />~ MONITORING PERIOD
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<br />•• Form Approved.
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<br />Approve/ eipiree 05.31-98
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<br />NAME/TITLE PRINCIPAL EXECUTIVE OFFICER I cER71FY uNDI:R PENALTY of uw iNAT I HAVE PERSONALLr ExAMINED MD TELEPHONE DATE
<br /> AM FAMIUM WITH THE INFORMATION SUBMITTED HEREIN; AND BASED ON „
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<br />.,ICT1ilYd MIIIi MY INQUIRY OF THOSE INDIVIDUALS IMMEDIATELY RESPON98LE FOR
<br />08TAININO THE INFORMATON, I BELIEVE THE SUBMITTED INFORMATION IS
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<br />ACCURATE AND COMPLETE
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<br />SIOMIFICMT PENALTIES FOR SUBMITTING FALSE INFORMATION
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<br />EpA Form 3320.1 (08.95) Previous editions may be used. (REPLACES EPA FORM T30 WHICH MAY NOT BE USED.1 J J J J J / 'y ;, ~: ) . ~„ ~ v'J u'1 PAGE _ OF
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