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PERMTfTEE NAME/ADDRE88 gAeYa47r1/Iq Nar/L«.eaaa dDlfi,rd NATIONN. POLLUTMT DIBCNMOE EUMINATON tYBTEM /NPDESI
<br />NAME ;T-„".-•"^~ ~ 1 ~ DRiCHARGE MONITORING REPORTPORT D
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<br />~'~ E/ L' a. ~ 5 / I I1 r ~?' N y 771) MONITORING PERIOD
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<br />Form Approved.
<br />•, / ."! ' QMB~No; 2040-Ot~p
<br />Approveltsxpj{s~ 06.31.98•
<br />NOTE: Reed Inetlugtlerr before oompNtlnp thb form.
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<br />NAME/TITLE PRINCIPAL EXECUTIVE OFFICER I CERTI
<br />AM FA FY UNDER PFNN.TY Of l
<br />MILIM WITH THE INFO AW THAT I NAVE PERSONALLY E%AMIN
<br />RMATION 9U9MITTED HEREIN
<br />MO 9A EO MD
<br />9ED ON TELEPHONE DATE
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<br />MY INQUIRY OF MORE INDIVIDUN.9 IMMEDIATELY RESPON98 LE FOR 1 <-~
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<br />, OBTNNINO ME INFORMATION, 19EUEVE THE SUBMITTED INFORMA TION IS
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<br /> TRUE, ACCUMTE MD COMPLETE. I M1 AWME THAT ME
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<br />I THE P093191UTY OF RNE MD IMPIUSONMENT. 9EE 76 U.S.C. 1 1001 MD 37 ~
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<br />TYPED OR PRINTED Wev nrial,lvn iAry/rm~,t a/Mn.rnemanaN rM6f.ra/ OFFlCER OR AUTHORIZED AOENi ~
<br />,OpE NUMBER YEAR MO DAV
<br />COMMENTS AND El(PLANA7ION Vh ANY VIVLAIIVNS l/f171lIOCe e//efr~enments nere/
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<br />EPA Form 332 ~1 1
<br />8.95) Previous editions mey be used. (REPLACES EPA FORM T-40
<br />WHICH MAY NOT BE USED.1 ') ', ; : „ ~ / ,) 61 Z 1 ] - 1 2 21 PAGE IOF
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