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<br />NATIONAL POLLUTANT DISCHARGE ELIMINATION SYSTEM /NPDES) Form Approved.
<br />OISCHAR GE MONITORING REPORT (OMR;9j ~ i OMB No. 2040-0004
<br />~• Approval expires OS-31-9R
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<br />NAME/TITLE PRINCIPAL EXECUTIVE OFFICER I CERTIFY UNDER PEIIALTY OF LAW THAT I HAVE PERSONALLY ExAMINED AND
<br />AM FAMILIAR WITH THE INFORMATION SUBMITTED HEREIN: ANO EASED ON MY
<br />'~ TELEPHQNE DATE
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<br />,' IIJOUIRY OF THOSE INDIVIDUALS IMMEDIATELY RESPONSIBLE FOR OBTAINING
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<br />I BELIEVE THE SUBMITTED INFORMATION IS TRUE '
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<br />COMMENTS AND EXPLANATION OF ANY VIOLATIONS (Re/erence all attachments here)
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<br />EPA Form 3320.7 (OS-95) Previous etlitions may not be used. (REPLACES EPA FORM T-40 WHICH MAY NOT BE USED.) G C 1 E 5 / C G C ] ] ] -1 E i C PAGE OF
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