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<br />M ATIOMAL PO LLV TANT DIICNARGF ELIMINATION SYSTEM (NPDEJI
<br />D ISCMAq GE MONITORING REPORT lOMRI
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<br />-ERMIT NVM~lR R1scNAwcr NUM•Ew
<br />MONITORING PERIOD
<br />YEAR MO OAY YEAR MO DAY
<br />FROM ; 1. _. TO 1 `~ - I .
<br />110~1/I 111131 /14~1J1 11617/ /1819/ 130-311
<br />Form Approved.
<br />! - ~ • ^) OMB No.2040-0004.
<br />- _ .. ~ Approval expires 6-30.91.
<br />N07E: Bead instructions befor~pletinp this form.
<br /> (3 Cprd Only) QUANTITY OR LOADING (1 Card Only) OU ALITY OR CONCENTRATION FP£OUENCY
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<br />NAME/TITLE PRINCIPAL EXECUTIVE OFFICER ' CERTIFY
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<br />AND AM FAMILIAR WITH THE INFORM1ilON SUBMITTED NEREIN
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<br />ON MY INpIMY OF THOS[ INOVIDUALS IMMEOIATCLY RCSPONYBLC FOR ~ I
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<br />d = OBTAINING THE INFCRMATIO`I I BELIEVE TH[ $UBMITED INFORMATION
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<br />NIFICANT PCNALTIES FOR SV BMITTMG FALSE INFORMATON INC
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<br />THE PDSbBILITV OF FINE AND IMPRISONMENT SEC IB USC { ICOI ANp _ _
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<br />SIGNATURE OF PRINCIPAL EXECUTIVE
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<br />TYPED OR PRINTED ^•d.,. manN.m mlpru.mm.nr ~./ArmvnC m.;vA. Rnds.w..; OFFICER OR AUTHORIZED AGENT A A NUMBER YEAR MO DAY
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